Delirium, Postoperative Complications
Conditions
Keywords
dementia, MCI, Aricept, Adverse Effects, Hospital Acquired Complications, Cognitive Impairment, Aging
Brief summary
The purpose of this study is to evaluate the feasibility of using Donepezil to prevent post-operative cognitive decline (POCD) among individuals aged 65 and older who have a baseline mild cognitive impairment (MCI) and are undergoing elective hip or knee replacement.
Detailed description
Up to 65% of elderly patients undergoing hip or knee surgery suffer from declining brain function known as post-operative cognitive decline (POCD). These individuals often stay in the hospital longer, have more complications, and are more likely to die. Recent clinical studies have shown the potential benefit of enhancing the cholinergic system among patients with both Alzheimer's disease and / or vascular dementia. Donepezil is currently being used to treat memory loss in patients with Alzheimer's disease. This study will recruit 30 cognitively impaired adults aged 65 or older who are scheduled to have elective hip or knee replacement surgery at University Hospital. Participants will be randomized to receive either a three to six week supply of Donepezil or a matching placebo approximately 4 weeks prior to surgery. This study will evaluate the effect of Donepezil on delirium incidence and severity during hospitalization, global cognitive function, length of hospitalization, site of discharge, and adverse drug effects. All material to be collected will be from interviews, questionnaires, and medical chart review. Some will be at baseline, during hospitalization, and 12 weeks post hospitalization and others will be daily during hospitalization. The International Study of Post-Operative Cognitive Decline battery of tests will be used in assessment, as will the CogHealth computerized battery.
Interventions
DRUGDonepezil
Sponsors
Pfizer
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Community-dwelling individuals aged 65 or older * Scheduled for elective hip or knee replacement at University Hospital * Mild cognitive impairment, defined as: * MMSE total score of 27 or less; * normal performance of the activities of daily living tasks of the Bristol scale after excluding mobility related difficulties; * no chart-based dementia diagnosis; and * no history of ever being on dementia medications such as Memantine or any cholinesterase inhibitors * Consent to participate in the study
Exclusion criteria
* Chart-based dementia diagnosis * MMSE score greater than 27 * Difficulty performing the activities of daily living not related to mobility as measured by the Bristol scale * Current or past history of receiving dementia medications such as Memantine or any cholinesterase inhibitors (Tacrine, Donepezil, Rivastigmine, or Galantamine) * Metastatic cancer or other comorbid illnesses likely to reduce life expectancy to under 6 months * Multiple trauma or pathological fractures requiring acute hip or knee replacement * Aphasic, blind, or deaf * Use of neuroleptics one month prior to surgery * Allergy to donepezil * Inability to read and complete study tests and forms * Alcohol or drug dependence, defined as intake of more than 5 units of alcohol daily during the past 3 months * Not expected to be discharged from hospital or able to complete the 3-month postoperative test * Not competent to make medical decisions
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Changes in the International Study of Post-Operative Cognitive Decline (ISPOCD) and the CogHealth computerized battery tests at 1 week and 12 weeks after surgery | — |
Secondary
| Measure | Time frame |
|---|---|
| Delirium status measured by the Confusion Assessment Method (CAM) and the Memorial Delirium Assessment Scale (MDAS) daily during the post-operative period | — |
| Global cognitive status assessed using the Mini Mental Status Exam (MMSE) | — |
| Length of stay in the hospital post-operatively | — |
| Discharge site | — |
| Adverse effects | — |
Countries
United States
Outcome results
None listed