Does desmopressin produce more cognitive problems and delirious symptoms in independent geriatric outpatients with nocturnal polyuria (NP)?

Objectives: To show a relation between the nocturnal polyuria, its therapy with desmopressin and cognitive alterations and delirious symptoms. Methodology: Prospective, randomized, mono-center, mono-national, double-blind, placebo-controlled, fixed-dose, parallel group comparative trial, with 110 patients, 55 patients per treatment group using desmopressin acetate nasal spray, strength: 0.1 mg/mL, nasal once a day of 10 mg/spray blast. Measurement: NP positive patients (> 33% nocturnal urine output volume [ADH positive or negative]) were treated over 10 days with intranasal spray in the evening time (7 p.m.), drug or placebo. On day 2, 5 and 10 the patients were interviewed about voiding frequency, sleeping behavior and subjective and cognitive alterations and delirium. Results: There was no correlation to be found between NP and the incidence of delirious symptoms or cognitive alterations. But the Mann-Whitney U-Test showed a superiority for delirious symptoms and forgetfulness under effective treatment with desmopressin (P = 0.0279). Delirious symptoms showed to be significantly more frequent under desmopressin treatment in the final assessment (results last value, P = 0.0297; changes from baseline, P = 0.0340; percentage changes from baseline, P = 0.0373). The variance analysis with repeated measures approved no significant augmentation of delirious symptoms under desmopressin. Conclusion: In this 10-day, clinical trial desmopressin was not significantly correlated with more delirious symptoms and forgetfulness in independent geriatric outpatients. NP and the disturbance of sleep were not correlated with delirium or cognitive decline. (C) 2017 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.