WHO's 2026 delirium work may not change care yet for people with mild cognitive impairment because the global guideline is still being developed. Medication reviews can still improve safety, but lasting memory improvement from deprescribing for MCI remains unproven. Delirium means sudden confusion, reduced attention and changed awareness, often triggered by illness or medicines in older adults. Mild cognitive impairment means noticeable memory or thinking changes that do not remove independence, and deprescribing means carefully lowering or stopping a risky medicine under clinical supervision.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Table of Contents
- What WHO is building now
- How hospitals treat delirium agitation now
- Why MCI benefits remain unproven
- What a medication review can still do
What WHO is building now
WHO is developing its first global guideline on prevention, diagnosis and management of delirium in older adults, explicitly including medication safety and deprescribing. According to WHO, the project was still recruiting experts and a methodologist in 2026, described in the WHO recruitment notice.
That timing matters for families. No final recommendations, drug lists or treatment changes for MCI follow from this work yet. WHO describes delirium as common, serious, often preventable and linked to higher illness, death, functional decline and costs.
How hospitals treat delirium agitation now
A U.S. cohort of adults 65 and older treated for delirium after hospital admission compared trazodone with atypical antipsychotics. According to the Marcus Institute for Aging Research, trazodone was linked to lower death and rehospitalization than drugs such as quetiapine, risperidone or olanzapine in the institute's study summary.
The American Psychiatric Association takes a cautious line on antipsychotics. According to Medscape's reporting, its 2025 delirium guideline reserves antipsychotics for severe agitation or psychosis after calming steps and reversible causes are addressed, as detailed in the APA guideline report. The same guideline advises against routine benzodiazepines because they can worsen delirium. For readers, the point is narrow: sedation is not the same as delirium treatment.
Why MCI benefits remain unproven
Medicine-optimization programs for dementia or MCI generally reduced drug counts and improved appropriateness, and appeared safe. Examples include stopping unneeded sleep aids, duplicate anticholinergics and sedating allergy or bladder drugs. The evidence for thinking and memory is weaker.
According to Cochrane, three randomized trials with 299 participants found very-low-certainty, inconsistent effects of anticholinergic deprescribing on cognition, reported in the Cochrane review summary. No difference was found for falls, quality of life or function in that review. So a lower pill count does not prove sharper memory.
What a medication review can still do
For MCI, clinicians can still review medicines for sedation, delirium risk, falls and anticholinergic burden. Bring every prescription, over-the-counter product, sleep aid, allergy pill, pain medicine and supplement.
Ask directly about these common trouble spots: Do not expect a promise of better memory from the review. The practical gain now is fewer side effects and a clearer plan for monitoring change.
- daytime sleepiness, slurred thinking, unsteadiness or recent falls
- new confusion after starting or raising a dose
- nighttime sedatives, strong allergy medicines and bladder medicines with anticholinergic effects
- whether each drug still has a clear purpose, safe dose and stop plan
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