Recenser la littérature portant sur l'effet des psychostimulants sur les fonctions cognitives des patients en fin de vie atteints de delirium hypoactif ou de troubles cognitifs.
Méthode:
Une revue de la littérature anglophone et francophone a été réalisée au moyen de mots clés désignant le delirium-cognition, les psychostimulants et les soins palliatifs dans les bases de données MEDLINE (1966-mars 2008), Embase (1974-mars 2008), PsycINFO (1806-mars 2008), IPA (1970-mars 2008), CINAHL (1982-mars 2008), ISI Web of Science (1945-mars 2008), Current Contents (mars 2007-mars 2008), Access Medicine (2001-mars 2008) et ProQuest Dissertations & Theses (1980-mars 2008). Pour ětre retenue, une étude devait avoir été effectuée auprès d'adultes en soins palliatifs présentant des troubles cognitifs non reliés à une démence ou à un delirium hyperactif–mixte. Une évaluation objective des fonctions cognitives devait avoir été réalisée avant et après le début du traitement psychostimulant. Ce dernier devait avoir été instauré après l'apparition des troubles cognitifs.
Résultats:
Au total, 173 résumés d'étude ont été révisés. Cinq études sur le méthylphénidate et une sur la caféine ont été retenues, soit 2 rapports de cas, 2 études prospectives ouvertes et 2 essais croisés randomisés à double insu contrôlés par placebo. Trois études ont été réalisées auprès de patients atteints de delirium hypoactif.
Conclusions:
Les études recensées soutiennent l'utilisation du méthylphénidate pour améliorer les fonctions cognitives des patients en fin de vie, notamment chez les patients en delirium hypoactif. La caféine semble avoir un effet bénéfique sur l'activité psychomotrice chez cette population.
Objective:
To review the research about psychostimulant effects on cognitive functions in end-of-life patients diagnosed with hypoactive delirium or cognitive disorders.
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