• Tareef Al-Aama, Christopher Brymer, Iris Gutmanis, Sarah M Woolmore-Goodwin, Jacquelin Esbaugh, and Monidipa Dasgupta.
• Department of Medicine-Geriatrics, UWO, Canada. dr_tareef@yahoo.com
• Int J Geriatr Psychiatry. 2011 Jul 1;26(7):687-94.

BackgroundDisturbance in the metabolism of tryptophan and tryptophan-derived compounds (e.g., melatonin) may have a role in the pathogenesis of delirium.ObjectiveTo evaluate the efficacy of low dose exogenous melatonin in decreasing delirium.DesignA randomized, double-blinded, placebo-controlled study.SettingAn Internal Medicine service in a tertiary care centre in London, Ontario, Canada.Participants145 individuals aged 65 years or over admitted through the emergency department to a medical unit in a tertiary care hospital.InterventionPatients were randomized to receive either 0.5 mg of melatonin or placebo every night for 14 days or until discharge.MeasurementsThe primary outcome was the occurrence of delirium as determined by Confusion Assessment Method (CAM) criteria.ResultsOf a total of 145 individuals (mean age (standard deviation): 84.5 (6.1) years) 72 were randomly assigned to the melatonin group and 73 to the placebo group. Melatonin was associated with a lower risk of delirium (12.0% vs. 31.0%, p = 0.014), with an odds ratio (OR), adjusted for dementia and co-morbidities of 0.19 (95% confidence intervals (CI): 0.06-0.62). Results were not different when patients with prevalent delirium were excluded.LimitationAn intention to treat analysis was not possible due to loss to follow-up.ConclusionExogenous low dose melatonin administered nightly to elderly patients admitted to acute care may represent a potential protective agent against delirium.Copyright © 2010 John Wiley & Sons, Ltd.

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