Melatonin decreases delirium in elderly patients: A randomized, placebo-controlled trial
Melatonin decreases delirium in elderly patients: A randomized, placebo-controlled trial
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DOI：
10.1002/gps.2582
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发表时间：
2011-07-01
影响因子：
4
通讯作者：
Dasgupta, Monidipa
中科院分区：
文献类型：
--
作者：
Al-Aama, Tareef;Brymer, Christopher;Dasgupta, Monidipa
背景：色氨酸和色氨酸衍生化合物（如色氨酸）代谢紊乱。例如，在一个实施例中，目的：评价低剂量外源性褪黑素减少谵妄的疗效。设计：一项随机、双盲、安慰剂对照研究。设置：加拿大安大略伦敦三级护理中心的内科服务。参与者：145名年龄在65岁或以上的人通过急诊科进入三级保健医院的医疗单位。干预措施：患者被随机分配接受褪黑激素或安慰剂0.5毫克，每晚14天或直到出院。测量：主要结果是谵妄的发生，由混乱评估方法（CAM）标准确定。在总共145名个体中（平均年龄（标准差）：84.5（6.1）岁），72名被随机分配到褪黑激素组，73名被随机分配到安慰剂组。褪黑激素与较低的谵妄风险相关（12.0% vs. 31.0%，p=0.014），经痴呆和合并症校正后的比值比（OR）为0.19（95%置信区间（CI）：0.06-0.62）。结果并没有不同时，流行性谵妄患者excluded.Limitation：意向治疗分析是不可能的，由于损失follow-up.Conclusion：外源性低剂量褪黑激素每晚给予老年患者急性护理可能是一个潜在的保护剂对谵妄。版权所有（C）2010约翰威利父子有限公司
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.Design: A randomized, double-blinded, placebo-controlled study.Setting: An Internal Medicine service in a tertiary care centre in London, Ontario, Canada.Participants: 145 individuals aged 65 years or over admitted through the emergency department to a medical unit in a tertiary care hospital.Intervention: Patients were randomized to receive either 0.5 mg of melatonin or placebo every night for 14 days or until discharge.Measurements: 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 comorbidities of 0.19 (95% confidence intervals (CI): 0.06-0.62). Results were not different when patients with prevalent delirium were excluded.Limitation: An intention to treat analysis was not possible due to loss to follow-up.Conclusion: Exogenous low dose melatonin administered nightly to elderly patients admitted to acute care may represent a potential protective agent against delirium. Copyright (C) 2010 John Wiley & Sons, Ltd.