Journal of Korean Society of Geriatric Neurosurgery 2008;4(1):31-34.
Published online June 30, 2008.
Donepezil is Effective for Acute Post-traumatic Delirium in Controlling Agitation & Disturbed Sleep/wake Cycle
Jae-Chang Song , Hyeong-Joong Yi

Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea

Abstract
Object: Acute agitation or delirium is a relatively well-known syndrome following traumatic brain injury (TBI). However, there has been no practical consensus for appropriate management protocol. Besides the normal aging process, some structural and functional derangements within the brain is attributed to this behavioral dysfunction, hence treatment is aimed to correct abnormal neurochemical substances. The aim of this study was to evaluate the effect of donepezil in such patients and assessed their short-term results within context of behavioral modification.
Methods
During the last 1 year, donepezil was prescribed, in trial basis, to eight patients who showed acute delirium following TBI. Decision whether to start or not was depended on the results of K-MMSE, GDS and CAM score scales. These data were gathered and compared each other between those obtained before and after donepezil prescription.
Results
All patients showed clinical and neuropsychiatric examination features compatible with delirium. Donepezil was started at a dose of 5 mg once a day, and increased to 10 mg, in 2 weeks. At 6 or 8 weeks to 3 months postmedication, examinations were repeated and showed the improvement both in clinical and examining profiles by 3-months post-medication, except 1 patient with concurrent spinal hemorrhage. Improvement was prominent in control of agitation and disturbed sleep/wake cycle.
Conclusion
Because there are numerous factors for improving delirious symptoms and precluding dementic conversion in this vulnerable period, in addition to the lack of knowledge for natural history, we are not sure about efficacy of donepezil in short-term period. Despite these drawbacks, donepezil seems to be effective in controlling acute symptoms of delirium in a certain degrees. More research and clinical relevance should be provided to gain validity.
Key Words: AgitationㆍDeliriumㆍDonepezilㆍSleep/wake cycleㆍTraumatic brain injury (TBI)
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