***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Recent studies suggest that delirium is associated with risk of dementia and also acceleration of decline in existing dementia . However , previous studies may have been confounded by incomplete ascertainment of cognitive status at baseline . Herein , we used a true population sample to determine if delirium is a risk factor for incident dementia and cognitive decline . We also examined the effect of delirium at the pathological level by determining associations between dementia and neuropathological markers of dementia in patients with and without a history of delirium . The Vantaa 85 + study examined 553 individuals ( 92 % of those eligible ) aged ≥85 years at baseline , 3 , 5 , 8 and 10 years .  Brain autopsy was performed in 52 % . Fixed and r and om-effects regression models were used to assess associations between ( i ) delirium and incident dementia and ( ii ) decline in Mini-Mental State Examination scores in the whole group . The relationship between dementia and common neuropathological markers ( Alzheimer-type , infa rcts and Lewy-body ) was modelled , stratified by history of delirium . Delirium increased the risk of incident dementia ( odds ratio 8.7 , 95 % confidence interval 2.1–35 ) . Delirium was also associated with worsening dementia severity ( odds ratio 3.1 , 95 % confidence interval 1.5–6.3 ) as well as deterioration in global function score ( odds ratio 2.8 , 95 % confidence interval 1.4–5.5 ) . In the whole study population , delirium was associated with loss of 1.0 more Mini-Mental State Examination points per year ( 95 % confidence interval 0.11–1.89 ) than those with no history of delirium . In individuals with dementia and no history of delirium ( n = 232 ) , all pathologies were significantly associated with dementia . However , in individuals with delirium and dementia ( n = 58 ) , no relationship between dementia and these markers was found . For example , higher Braak stage was associated with dementia when no history of delirium ( odds ratio 2.0 , 95 % confidence interval 1.1–3.5 , P = 0.02 ) , but in those with a history of delirium , there was no significant relationship ( odds ratio 1.2 , 95 % confidence interval 0.2–6.7 , P = 0.85 ) . This trend for odds ratios to be closer to unity in the delirium and dementia group was observed for neuritic amyloid , apolipoprotein ε status , presence of infa rcts , α-synucleinopathy and neuronal loss in substantia nigra . These findings are the first to demonstrate in a true population study that delirium is a strong risk factor for incident dementia and cognitive decline in the oldest-old . However , in this study , the relationship did not appear to be mediated by classical neuropathologies associated with dementia There is ample evidence that the poststroke confusion syndrome or delirium is a manifestation of cholinergic deficit . Given this conception , we conducted a controlled study of efficacy and safety of acetylcholinesterase inhibitor rivastigmine in patients developed a delirium in the acute phase of ischemic stroke . The study included 224 consecutive stroke patients : 68 patients developed a delirium in the acute phase of disease . Severity of delirium was scored with the Delirium Rating Scale ( DRS ) . A main group included 21 patients with delirium treated with rivastigmine in individually tailored doses . A control group included 47 patients with delirium who received only vascular and anticoagulant treatment , i.e. haloperidol .  Cognitive functions were tested 3 and 6 months after stroke with the MMSE , the FAB , the Luria 10 point verbal test . The Zarit Burden Interview ( ZBI ) was used after 3 and 6 months to measure caregiver burden . In patients treated with rivastigmine , the delirium phase was significantly shorter ( p<0,001 ) compared to the control group . In patients without delirium in the acute phase of stroke , the results of neuropsychological study were better ( p<0,001 ) than in patients with delirium . Total ZBI scores were more favorable in the rivastigmine group than in the control one ( p<0,05 ) . To the end of the study , 5 patients died in the rivastigmine group , 17 patients in the control group and 3 patients in the group without delirium . Rivastigmine was safe in the acute phase of stroke patients even after the rapid titration Background : Major depression is a frequent and serious disorder in older medical in patients . Because the condition goes undetected and untreated in most of these patients , we conducted a r and omized clinical trial to evaluate the effectiveness of a strategy of systematic detection and multidisciplinary treatment of depression in this population . Methods : Consecutive patients aged 65 years or more admitted to general medical services in a primary care hospital between October 1999 and November 2002 were screened for depression with the Diagnostic Interview Schedule ( DIS ) within 48 hours after admission . Patients found to have major depression were r and omly allocated to receive the intervention or usual care . The intervention involved consultation and treatment by a psychiatrist and follow-up by a research nurse and the patient 's family physician . Research assistants , blind to group allocation , collected data from the patients at enrolment and at 3 and 6 months later using the Hamilton Depression Rating Scale ( HAMD ) , the Medical Outcomes 36-item Short Form ( SF-36 ) , the DIS , the Mini-Mental State Examination ( MMSE ) , the Older Americans Re sources and Services ( OARS ) question naire to assess basic and instrumental activities of daily living ( OARS-ADL and OARS-IADL ) and the Rating Scale for Side Effects . Data on the severity of illness , length of hospital stay , health services and medication use , mortality and process of care were also collected . The primary outcome measures were the HAMD and SF-36 . Results : Of 1500 eligible patients who were screened , 157 were found to have major depression and consented to participate ( 78 in the intervention group and 79 in the usual care group ) . At r and omization , there were no clinical ly or statistically significant differences between the 2 groups . Sixty-four patients completed follow-up to 6 months , 57 withdrew , and 36 died . At 6 months , there were no clinical ly or statistically significant differences the 2 groups in HAMD or SF-36 scores or any of the secondary outcome measures . Interpretation : We were unable to demonstrate that systematic detection and multidisciplinary care of depression was more beneficial than usual care for elderly medical in patients Context : Little is known about the relationship between sedative drugs used preoperatively and postoperative delirium . Melatonin is a drug used to se date patients preoperatively and is hypothesized by recent works to have a curative effect on postoperative delirium . Aims : The incidence of postoperative delirium will be tested if affected by three different sedative drugs including melatonin . Setting s and Design : Controlled r and omized doubleblind study . Patients and Methods : Three-hundred patients aged>65 years scheduled for hip arthroplasty under spinal anesthesia were r and omly distributed to one of the four groups . Group 1 ( control ) received nothing for sedation . Group 2 ( melatonin ) received 5 mg melatonin . Group 3 ( midazolam ) received 7.5 mg midazolam . Group 4 ( clonidine ) received 100 μg clonidine . These medications were given orally at sleep time at night of operation and another dose 90 min before operative time . Patients who developed postoperative delirium received 5 mg of melatonin 9 pm for three successive days in a trial to treat delirium . Statistical Analysis Used : Statistical analysis was done using the SPSS Software ( version 13 ) . Results : Total of 222 patients completed the study . Percentage of postoperative delirium in the control group was 32.65 % ( 16/49 patients ) . The melatonin group showed a statistically significant decrease in the percentage of postoperative delirium to 9.43 % ( 5/53 patients ) . Melatonin was successful in treating 58.06 % of patients suffered postoperative delirium ( 36/62 patients ) with no difference between different groups . Conclusions : Postoperative delirium is affected with the drug used for preoperative sedation . Melatonin was successful in decreasing postoperative delirium when used preoperatively and in treating more than half of patients developed postoperative delirium when used for three postoperative nights OBJECTIVES To determine whether a delirium abatement program ( DAP ) can shorten duration of delirium in new admissions to postacute care ( PAC ) . DESIGN Cluster r and omized controlled trial . SETTING Eight skilled nursing facilities specializing in PAC within a single metropolitan region . PARTICIPANTS Four hundred fifty-seven participants with delirium at PAC admission . INTERVENTION The DAP consisted of four steps : assessment for delirium  within 5 days of PAC admission , assessment and correction of common reversible causes of delirium , prevention of complications of delirium , and restoration of function . MEASUREMENTS Trained research ers screened eligible patients . Those with delirium defined according to the Confusion Assessment Method were eligible for participation using proxy consent . Regardless of location , research ers blind to intervention status re-assessed participants for delirium 2 weeks and 1 month after enrollment . RESULTS Nurses at DAP sites detected delirium in 41 % of participants , versus 12 % in usual care sites ( P<.001 ) , and completed  DAP  documentation in most participants in whom delirium was detected , but the DAP intervention had no effect on delirium persistence based on two measurements at 2 weeks ( DAP 68 % vs usual care 66 % ) and 1 month ( DAP 60 % vs usual care 51 % ) ( adjusted P > or = .20 ) . Adjusting for baseline differences between DAP and usual care participants and restricting analysis to DAP participants in whom delirium was detected did not alter the results . CONCLUSION Detection of delirium improved at the DAP sites , but the DAP had no effect on the persistence of delirium . This effectiveness trial demonstrated that a nurse-led DAP intervention was not effective in typical PAC facilities BACKGROUND Delirium is a common syndrome with poor prognosis affecting elderly in patients . Treatment is mainly based on common sense with wide variations in practice . We investigated whether intensified , multicomponent geriatric treatment could improve the prognosis of delirious patients . METHODS We performed a r and omized , controlled trial of 174 patients with delirium in six general medicine units from an acute hospital in Helsinki , Finl and . The intervention group received individually tailored geriatric treatment . The primary endpoint was the sum of those deceased individuals and the patients permanently institutionalized . Secondary endpoints included the number of days in hospitals and other institutions , delirium intensity , and cognition . RESULTS The mean age of patients was 83 years , and 31 % had previous dementia . The intervention group ( N = 87 ) received significantly more  acetylcholinesterase inhibitors  ( 58.6 % vs 9.2 % ) ,  atypical antipsychotics  ( 69.8 % vs 30.2 % ) ,  specialist consultations  ( 49.4 % vs 28.7 % ) ,  hip protectors  ( 88.5 % vs 3.4 % ) , physiotherapy ( 87.4 % vs 47.1 % ) , and fewer conventional neuroleptics ( 8.0 % vs 23.0 % ) than did the control group ( N = 87 ) . During the 1-year follow-up , 60.9 % of the intervention group and 64.4 % of controls were either deceased or permanently institutionalized ( p = .638 ) . The intervention group spent a mean of 126 days in institutions , and the control group 140 days ( p = .688 ) . Delirium was , however , alleviated more rapidly during hospitalization , and cognition improved significantly at 6 months in the intervention group . CONCLUSIONS Faster alleviation of delirium and improved cognition justify good , comprehensive geriatric care for these patients although treatment produced no significant improvements in hard endpoints of prognosis BACKGROUND Since in hospitalized older patients delirium is associated with poor outcomes , we evaluated the effectiveness of a multicomponent strategy for the prevention of delirium . METHODS We studied 852 patients 70 years of age or older who had been admitted to the general-medicine service at a teaching hospital . Patients from one intervention unit and two usual-care units were enrolled by means of a prospect i ve matching strategy . The intervention consisted of st and ardized protocol s for the management of six risk factors for delirium : cognitive impairment , sleep deprivation , immobility , visual impairment , hearing impairment , and dehydration . Delirium , the primary outcome , was assessed daily until discharge . RESULTS Delirium developed in 9.9 percent of the intervention group as compared with 15.0 percent of the usual-care group , ( matched odds ratio , 0.60 ; 95 percent confidence interval , 0.39 to 0.92 ) . The total number of days with delirium ( 105 vs. 161 , P=0.02 ) and the total number of episodes ( 62 vs. 90 , P=0.03 ) were significantly lower in the intervention group . However , the severity of delirium and recurrence rates were not 
    Output:
    
The six non-pharmacological intervention studies showed no impact on duration of delirium , mortality or institutionalization , but a decrease in severity of delirium and improvement in medium-term cognitive function were observed .
The four studies with pharmacological interventions found that rivastigmine reduced the duration of delirium , improved cognitive function and reduced caregiver burden ;  olanzapine and haloperidol decreased the severity of delirium ;  droperidol  reduced length of hospitalization and improved delirium remission rate .
However , the improvements in delirium duration and severity suggest these drugs are effective in treating the condition .
Once delirium has developed , non-pharmacological treatment seems less effective in controlling symptoms , and there is a lack of studies describing different non-pharmacological interventions