title: Rivastigmine patch reduces the incidence of postoperative delirium in older patients with cognitive impairment.
abstract: OBJECTIVE
  To date, data regarding the efficacy of acetylcholinesterase inhibitors in preventing postoperative delirium (POD) are inconsistent and conflicting. Older individuals with cognitive dysfunction are thought to show POD more frequently. Our aim was to study the effectiveness of rivastigmine prophylaxis on the incidence, severity, and risk factors for POD in older patients with cognitive impairment undergoing hip fracture surgery.
  
  
  METHODS
  Of 62 older patients with cognitive impairment about to undergo surgery after a hip fracture, 31 were randomly assigned to receive a rivastigmine patch from 3 days before to 7 days after the operation (Group I), and the other 31 did not receive a rivastigmine patch (Group II). The two groups were compared with regard to incidence and severity of delirium on postoperative days 2 or 3 and 7. Multivariate logistic regression analysis was performed to assess factors associated with POD.
  
  
  RESULTS
  Postoperative delirium occurred in five Group I patients and 14 Group II patients (p = 0.013). The mean severity of delirium in the two groups as determined by the Delirium Rating Scale was 2.2 and 6.2 respectively (p = 0.033). The odds ratio for POD was 0.259 (95% CI: 0.074-0.905, p = 0.034) after adjusting for American Society of Anesthesiologists score (p = 0.058), age (p = 0.203), and gender (p = 0.560). There were no rivastigmine-related perioperative complications.
  
  
  CONCLUSIONS
  Perioperative rivastigmine patch application could reduce the occurrence of POD in older patients with low cognitive status. Copyright © 2016 John Wiley & Sons, Ltd.
authors: Department of Neurology, College of Medicine, Chung-Ang University, Seoul, South Korea.
authors: Young Chul
authors: YC
authors: Youn
authors: Department of Neurology, College of Medicine, Chung-Ang University, Seoul, South Korea.
authors: Hae-Won
authors: HW
authors: Shin
authors: Department of Preventive Medicine, College of Medicine, Chung-Ang University, Seoul, South Korea.
authors: Byung-Sun
authors: BS
authors: Choi
authors: Department of Neurology, Seoul National University College of Medicine & Seoul National University Bundang Hospital, Seoul, South Korea.
authors: SangYun
authors: S
authors: Kim
authors: Department of Orthopaedic Surgery, College of Medicine, Chung-Ang University, Seoul, South Korea.
authors: Jung-Yeop
authors: JY
authors: Lee
authors: Department of Orthopaedic Surgery, College of Medicine, Chung-Ang University, Seoul, South Korea.
authors: Yong-Chan
authors: YC
authors: Ha
mesh_terms: D000279:Administration, Cutaneous; D000368:Aged; D000369:Aged, 80 and over; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage*; D060825:Cognitive Dysfunction / Q000150:complications*; D003693:Delirium / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D012307:Risk Factors; D000068836:Rivastigmine / Q000008:administration & dosage* / Q000627:therapeutic use*
chemical_list: D002800:Cholinesterase Inhibitors; D000068836:Rivastigmine
keywords: acetylcholinesterase inhibitors; cognitive impairment; delirium; postoperative delirium; risk factor