[Using psychostimulants in end-of-life patients with hypoactive delirium and cognitive disorders: A literature review].
OBJECTIVE
To review the research about psychostimulant effects on cognitive functions in end-of-life patients diagnosed with hypoactive delirium or cognitive disorders.


METHODS
The MEDLINE (1966-March 2008), Embase (1974-March 2008), PsycINFO (1806-March 2008), IPA (1970-March 2008), CINAHL (1982-March 2008), ISI Web of Science (1945-March 2008), Current Contents (March 2007-March 2008), Access Medicine (2001-March 2008), and ProQuest Dissertations & Theses (1980-March 2008) databases were searched with keywords related to delirium, cognition, psychostimulants, and palliative care for French or English articles in a dementia-free and hyperactive delirium-free end-of-life population. Cognitive functions had to be assessed before and after initiation of the psychostimulant treatment. Moreover, treatment had to be initiated after the onset of cognitive impairments.


RESULTS
A total of 173 studies were screened. Five studies on methylphenidate and 1 study on caffeine met inclusion criteria and were included in this review. Two studies were case reports, 2 were open-label trials, and 2 were double-blind, crossover randomized placebo-controlled trials. Three studies were conducted with hypoactive delirium patients and all studies were conducted in an advanced cancer patient population.


CONCLUSIONS
The reviewed studies support the use of methylphenidate to improve end-of-life patient cognitive functions, particularly in the case of hypoactive delirium. Caffeine seems to have beneficial effects on psychomotor activity. Further well-designed studies are needed to consolidate these findings.
Elie
Dominique
D
Université Laval, Québec.
Gagnon
Pierre
P
Gagnon
Bruno
B
Giguère
Anik
A
D000368:Aged; D002110:Caffeine / Q000627:therapeutic use*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000188:drug therapy*; D003221:Confusion / Q000188:drug therapy; D003693:Delirium / Q000188:drug therapy*; D003866:Depressive Disorder / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D006801:Humans; D008609:Mental Status Schedule; D008774:Methylphenidate / Q000627:therapeutic use*; D008875:Middle Aged; D010166:Palliative Care; D011596:Psychomotor Disorders / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D013727:Terminal Care
D000697:Central Nervous System Stimulants; D008774:Methylphenidate; D002110:Caffeine