Sigma-1 receptor agonist fluvoxamine for delirium in patients with Alzheimer's disease

Background: Delirium in older adults is a common and serious acute neuropsychiatric syndrome, with core features of inattention and global cognitive impairment. Although antipsychotic drugs are the medications most frequently used to treat this syndrome, these drugs are associated with a variety of adverse events, including sedation, extrapyramidal side effects, and cardiac arrhythmias. Methods: We report on two cases in which monotherapy of the selective serotonin reuptake inhibitor and sigma-1 receptor agonist fluvoxamine was effective in ameliorating the delirium of patients with Alzheimer's disease. Results: Delirium Rating Scale (DRS) scores in the two patients with Alzheimer's disease decreased after fluvoxamine monotherapy. Conclusion: Doctors should consider that fluvoxamine could be an alternative approach in treating delirium in patients with Alzheimer's disease because of the risk of extrapyramidal side effects by antipsychotic drugs.