Crit Care Med

Are acetylcholinesterase inhibitors effective at preventing or treating delirium?

September 4, 2025

Study details: This systematic review and meta-analysis evaluated the efficacy of acetylcholinesterase inhibitors (AChEIs) for delirium prevention and treatment in hospitalized patients. Ten randomized trials involving 731 patients (365 AChEI, 366 placebo) were included. Eight studies focused on prophylaxis (mostly perioperative) and two on treatment of established delirium. Outcomes assessed included delirium incidence, duration, severity, hospital length of stay (LOS), and adverse events.

Results: AChEIs significantly reduced delirium incidence (risk ratio, 0.68; 95% confidence interval, 0.47–0.98; p=0.039). No significant effects were observed for delirium duration (mean difference [MD], -0.16 days; p=0.23), severity (standardized MD, -0.08; p=0.74), or LOS (MD, -0.82 days; p=0.19). Subgroup analysis revealed a modest reduction in delirium severity when AChEIs were used preventively (SMD, -0.32; p<0.01). No increase in adverse events was noted.

Clinical impact: AChEIs may be considered for delirium prophylaxis in surgical patients, especially older adults, but aren’t effective for treating established delirium. These findings support targeted preventive use rather than broad therapeutic application.

Source:

Pipek LZ, et al. (2025, August 4). Crit Care Med. Acetylcholinesterase Inhibitors for Delirium Prevention: A Systematic Review and Meta-Analysis. https://pubmed.ncbi.nlm.nih.gov/40758382/