Does Melatonin Prevent Delirium In Elderly Surgery Patients?

Annemarieke de Jonghe Academic Medical Center University of Amsterdam Departement of Internal Medicine Section of Geriatric Medicine F4-218 Amsterdam, The NetherlandsMedicalResearch.com Interview with:
Annemarieke de Jonghe
Academic Medical Center
University of Amsterdam
Departement of Internal Medicine
Section of Geriatric Medicine F4-218
Amsterdam, The Netherlands

Medical Research: What are the main findings of the study?

Dr. de Jonghe: We investigated the preventive properties of melatonin versus placebo in a prospective cohort of elderly hip fracture patients (n=378). We found that 3mg melatonin vs placebo, given for 5 days from the day of admission, did not influence the incidence of delirium. However, in a posthoc analysis we found that more patients in the placebo group more often had a longer lasting delirium.


Medical Research: Were any of the findings unexpected?

Dr. de Jonghe: We started this study as we believed melatonin could be beneficial in the prevention of delirium. Clinical evidence linking melatonin to delirium was limited. Based on case reports of beneficial effects of melatonin in sundowning in dementia and on the observational evidence that a disrupted sleep wake cycle is present in delirium, we started this multicenter study. During the course of our study, 2 other studies (Sultan, Al-Aama) were published which showed very positive effects for both prevention and treatment of delirium with melatonin. We also noticed that incidence rates of delirium were lower than 5 years earlier in our hospital. So, by the time we started to analyse our data we were a bit surprised over the outcome. As we describe in our paper, there are different explanations possible for the lack of effect in our population.

Medical Research: What should clinicians and patients take away from your report?

Dr. de Jonghe: Melatonin is a promising product for the prevention of delirium which needs further investigation. One may consider using it, especially because of the absence of other safe and effective medical interventions.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. de Jonghe: More studies are warranted to explain the differences between the findings of the three RCTs that have now been performed comparing melatonin vs placebo as a prophylaxis in delirium. These studies should also determine specific patient groups that could benefit most from a prophylaxis with melatonin. It is also important to determine the dosage of melatonin.

Furthermore, we would recommend the inclusion of patients with cognitive impairment in delirium research. Most studies on delirium exclude patients with dementia whereas they are the most at risk for delirium and also delirium had negative impact on their cognitive function afterwards. In our study we included a real live population with a high mean age, 84 years and > 60% experienced cognitive problems.

Citation:

Effect of melatonin on incidence of delirium among patients with hip fracture: a multicentre, double-blind randomized controlled trial
Annemarieke de Jonghe, Barbara C. van Munster, J. Carel Goslings, Peter Kloen, Carolien van Rees, Reinder Wolvius, Romuald van Velde, Marcel Levi, Rob J. de Haan, Sophia E. de Rooij, and on behalf of the Amsterdam Delirium Study Group

CMAJ cmaj.140495; published ahead of print September 2, 2014, doi:10.1503/cmaj.140495