Winter 2013 – Can Donepezil Hydrochloride Reduce the Role of Neuroleptic Drugs in Delirium? A Case Report

Can Donepezil Hydrochloride Reduce the Role of Neuroleptic Drugs in Delirium? A Case Report.
Lloyd D Hughes*, Emily McKay.
Author Affiliations:
Medical School, Liverpool University, Liverpool, England

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*Corresponding author: Lloyd D. Hughes; L.D.Hughes[at]
Key Words: geriatrics; delirium; psychiatry; acetylcholinesterase inhibitors.
Background: Recent evidence shows that a confirmed diagnosis of delirium increases both patient morbidity and mortality. Importantly, these increases are independent of patient age, and presence of co-morbid disease. In the last few years, there has been evidence that acetylcholinesterase inhibitors may have a limited role in managing episodes of mild/moderate delirium. Methods: This case study reports a patient whose behavioral disturbances caused by delirium, responded well to donepezil hydrochloride in a nursing home in Dundee, United Kingdom. Results:Our clinical case focuses on a patient who was diagnosed with a mixed picture delirium after developing PUO. This case report notes that Mr A, a patient already prescribed donepezil hydrochloride, saw an improvement in his behavioral symptoms after an increase in his dose. This enabled the patient to avoid receiving neuroleptic or benzodiazepine medication, known to be particularly problematic in older patients.
Conclusion: The authors tentatively propose that patients in community care already prescribed acetylcholinesterase inhibitors, may benefit from an increased dose in cases of mild delirium (where there is no clear cause or requirement for hospital admission). In line with the significant impact that delirium has upon older patients in community care, we would call for further studies looking at the influence that these medications may have on the sequelae of delirium in patients in the community.

Published: February 27, 2013
Senior Editor: Skyler Johnson
Junior Editor: Bobby Gambhir
DOI: Pending

Hughes LD, McKay E. Can Donepezil Hydrochloride Reduce the Role of Neuroleptic Drugs in Delirium? A Case Report. Medical Student Research Journal. 2013;2(Winter):11-16.
Can donepezil hydrochloride reduce the role of
neuroleptic drugs in delirium? A case report

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Kevin Patterson

Executive Editor
Kevin Charles Patterson is a fourth year medical student at Michigan State University’s College of Human Medicine. He is in his eighth year at MSU after graduating with a B.S. in Human Biology and a B.S. in Microbiology, both in 2010. He is considering a career in internal medicine with a combined scientist training program in residency; after residency, his plans include the possibility of a fellowship and the ultimate goal of practicing academic medicine. Editor Note (2013-14): Kevin graduated, matched, and is a resident in Internal Medicine at Ohio State University Wexner Medical Center.