title: Melatonin decreases delirium in elderly patients: a randomized, placebo-controlled trial.
abstract: BACKGROUND
  Disturbance in the metabolism of tryptophan and tryptophan-derived compounds (e.g., melatonin) may have a role in the pathogenesis of delirium.
  
  
  OBJECTIVE
  To evaluate the efficacy of low dose exogenous melatonin in decreasing delirium.
  
  
  METHODS
  A randomized, double-blinded, placebo-controlled study.
  
  
  METHODS
  An Internal Medicine service in a tertiary care centre in London, Ontario, Canada.
  
  
  METHODS
  145 individuals aged 65 years or over admitted through the emergency department to a medical unit in a tertiary care hospital.
  
  
  METHODS
  Patients were randomized to receive either 0.5 mg of melatonin or placebo every night for 14 days or until discharge.
  
  
  METHODS
  The primary outcome was the occurrence of delirium as determined by Confusion Assessment Method (CAM) criteria.
  
  
  RESULTS
  Of a total of 145 individuals (mean age (standard deviation): 84.5 (6.1) years) 72 were randomly assigned to the melatonin group and 73 to the placebo group. Melatonin was associated with a lower risk of delirium (12.0% vs. 31.0%, p = 0.014), with an odds ratio (OR), adjusted for dementia and co-morbidities of 0.19 (95% confidence intervals (CI): 0.06-0.62). Results were not different when patients with prevalent delirium were excluded.
  
  
  CONCLUSIONS
  An intention to treat analysis was not possible due to loss to follow-up.
  
  
  CONCLUSIONS
  Exogenous low dose melatonin administered nightly to elderly patients admitted to acute care may represent a potential protective agent against delirium.
authors.affiliation: Department of Medicine-Geriatrics, UWO, Canada. dr_tareef@yahoo.com
authors.forename: Tareef
authors.initials: T
authors.lastname: Al-Aama
authors.forename: Christopher
authors.initials: C
authors.lastname: Brymer
authors.forename: Iris
authors.initials: I
authors.lastname: Gutmanis
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Woolmore-Goodwin
authors.forename: Jacquelin
authors.initials: J
authors.lastname: Esbaugh
authors.forename: Monidipa
authors.initials: M
authors.lastname: Dasgupta
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002492:Central Nervous System Depressants / Q000008:administration & dosage*; D003693:Delirium / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008550:Melatonin / Q000008:administration & dosage*; D009864:Ontario
chemical_list: D002492:Central Nervous System Depressants; D008550:Melatonin