Acute Confusional States (Delirium) in Stroke Patients

Abstract

Acute confusional states (ACS) were studied in 155 consecutive representative patients (mean age 73 years) with acute cerebrovascular disorders. Testing for ACS could be done in 94% of the patients. Sixty-nine of the 145 testable patients (48%) were acutely confused on admission or developed ACS within 7 days of admission. The mean age for the patients who developed ACS was 76 years compared with 69 years for patients without ACS (p < 0.001). Fifty-six of 113 patients (50%) with cerebral infarction, 6 of 21 patients (29%) with transitory ischemic attack and 7 out of 8 patients (88%) with intracerebral hemorrhage developed ACS. ACS were more common in patients with left-sided brain lesions (38/65; 58%) than in patients with right-sided brain lesions (18/47; 38%, p < 0.05). Multivariate analysis showed that extensive extremity paresis, previous ACS, left-sided brain lesions, old age and treatment with drugs with anticholinergic effects were independent predictors for ACS. ACS were associated with poststroke complications such as myocardial infarction, pulmonary embolism, pneumonia, deep vein thrombosis, urinary retention or urinary tract infection. Extensive paresis and ACS were the main independent predictors for discharge to geriatric rehabilitation.

Prevalence for delirium in stroke patients: A prospective controlled study

“…After controlling for confounding risk factors (higher age, dementia, disability on admission, increased CRP), delirious patients in our cohort had not a worse outcome, compared to similar patients without delirium. This is in contrast to other studies (Caeiro, Ferro, Albuquerque, & Figueira, 2004;Gustafson et al, 1991;Mitasova et al, 2012). Severely disabled, delirious patients have more complications and might have a worse rehabilitation on SU, even in short episodes of delirium.…”

“…Only one other study used a 24-hr screening, too (Gustafson et al, 1991), but found higher prevalence. Most positive screenings were during the night, hence screening rates of other studies, which used a once per day assessment, might have underestimated delirium prevalence (Caeiro et al, 2004;McManus et al, 2009;Miu & Yeung, 2013;Oldenbeuving et al, 2011).…”

“…Other studies in the field did not reported delirium-related structures and processes; hence a comparison is not feasible. Another influencing factor may be the inclusion of patients with TIA, who were included in other studies, too with a delirium prevalence of 10% (Dahl et al, 2010) and 48% (Gustafson et al, 1991).…”

“…In case, patients had a severe aphasia and/or dementia and could not respond to simple questions, the presence of disorientated behavior and its fluctuation in 24 hr was rated as criteria for delirium (Gustafson, Eriksson, Sture, Bucht, & Gösta, 1991) and confirmed by families by asking them for new onset of such behavior. Assessment of delirium according to the CAM and its subtypes was conducted by nurses in each shift, three times a day covering a 24-hr period (Lemiengre et al, 2006).…”

Delirium in acute stroke: screening tools, incidence rates and predictors: a systematic review

“…The designs employed in the studies included in this review were prospective studies (n=11), retrospective studies (n=3) case controls (n=3), one cross sectional study, one pilot study of treatment intervention and one study which was described as "observational" (see table 2). A total of 12 studies reported applying established diagnostic criteria when assessing patients for delirium: Six (30%) studies applied DSM IV[2, [23][24][25][26][27], three (15%) studies applied DSM III-R [28][29][30], two studies applied DSM IV-R [31,32], and one (5%) study applied DSM III [33]. Three studies referred to "clinical assessment" but did not detail any diagnostic guidelines [34][35][36], and one study referred to the diagnosis of "disorientation" using a simple 3 point scale [37].…”