BioMed Central | Full text | A pilot study of rivastigmine in the treatment of delirium after stroke; a safe alternativeThe electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1471-2377/8/34This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This pilot study was performed within an epidemiological study. In 527 consecutive stroke patients presence of delirium was assessed during the first week with the confusion assessment method. Severity was scored with the delirium rating scale (DRS). Sixty-two patients developed a delirium in the acute phase of stroke. Only patients with a severe and persistent delirium (defined as a DRS of 12 or more for more than 24 hours) were enrolled in the present study. In total 26 fulfilled these criteria of whom 17 were treated with orally administered rivastigmine with a total dose between 3 and 12 mg a day. Eight patients could not be treated because of dysphagia and one because of early discharge.Of the 17 patients with delirium, 12 had an infection and were treated with antibiotics. Seven patients had a metabolic disturbance that could causally be related to the delirium. Nine patients had a hyperactive/hyperalert type of delirium, 6 hypoactive/hypoalert, and 2 had a mixed type. In 16 of the 17 (94%) patients there was a decrease in severity of delirium following rivastigmine treatment (Figure 1). The mean DRS decreased from 14.8 at start of rivastigmine to 8.5 at individual maximum dose and 5.6 after tapering. Four patients needed 3 mg rivastigmine per day, 5 patients 6 mg, 5 patients 9 mg, and 2 patients needed 12 mg. The mean duration of the delirium in these 16 patients was 6.7 days (range 2 17).
