Agitation, Delirium, and Cognitive Outcomes in Intracerebral Hemorrhage

Abstract

Introduction Delirium predicts higher long-term cognitive morbidity. We previously identified a cohort of patients with spontaneous intracerebral hemorrhage and delirium, and found worse outcomes in Health Related Quality of Life (HRQoL) in the domain of Cognitive Function. We tested the hypothesis that agitation would have additional prognostic significance on later Cognitive Function HRQoL. Materials and Method Prospective identification of 174 patients with acute intracerebral hemorrhage, measuring stroke severity, agitation, and delirium with a standardized protocol and measures. HRQoL was assessed using the Neuro-QOL at 28 days, three months, and one year. Functional outcomes were measured with the modified Rankin Scale. Results Among the 81 patients with health related quality of life follow up data available, patients who had agitation and delirium had worse Cognitive Function HRQoL scores at 28 days (T-scores for delirium with agitation 20.9 ± 7.3, delirium without agitation 30.4 ± 16.5, agitation without delirium 36.6 ± 17.5, neither agitated nor delirious 40.3 ± 15.9, P=0.03), and at 1 year (P=0.006). The effect persisted in mixed models after correction for severity of neurologic injury, age, and time of assessment (P=0.0006), and was not associated with medication use, seizures or infection. Conclusions The presence of agitation with delirium in patients with intracerebral hemorrhage may predict higher risk of unfavorable cognitive outcomes up to one year later.

Delirium Assessment in Acute Stroke: A Systematic Review and Meta-Analysis of Incidence, Assessment Tools, and Assessment Frequencies

“…A total of 134 articles were read in full length and 30 were included in the review. 15-44 In these 30 articles, 24 unique populations were identified (Figure 1). The discrepancy between the number of articles and the number of unique populations was caused by the fact that the same population was described in more than one article.…”

Prophylactic Seizure Medication and Health-Related Quality of Life After Intracerebral Hemorrhage

“…Reductions in HRQoL, even if meaningful to patients, might not be detected by global, ordinal outcome scales, such as the modified Rankin Scale (mRS), a commonly utilized outcome measure for patients with ICH; a recent publication found no effect of prophylactic levetiracetam on the mRS.(9) Further, cognitive side effects may manifest as delirium symptoms, which is predictive of worse cognitive function HRQoL after ICH. (13–16) We hypothesized that prophylactic levetiracetam would be associated with lower cognitive function HRQoL after ICH.…”

The quality of life of patients developed delirium after coronary artery bypass grafting is determined by cognitive function after discharge: A cross‐sectional study

“…Postoperative delirium is associated with adverse outcomes including increased complications and mortality in the hospital and after discharge, increased health care costs, and the decline in physiological and cognitive function (Dong et al, ; Krenk & Rasmussen, ; Mu et al, ). Studies have found that POD after CABG was an independent predictor of cognitive impairment after discharge (Khadka et al, ; Naidech et al, ; Rosenthal et al, ), which may have a long‐term effect on QoL, while several other authors indicated that elderly patients who developed POD may not always have a poorer QoL after discharge (Hedeshian, Namour, Dziadik, Stewart, & Campos, ; Le Grande et al, ; Markou, van der Windt, van Swieten, & Noyez, ; Middel et al, ; Najafi, Sheikhvatan, Montazeri, & Sheikhfathollahi, ; Peric et al, ; Sen et al, ). These inconsistencies have been explained by that QoL is the result of the combination of multiple risk factors (Shan, Saxena, McMahon, & Newcomb, ) such as old age, female, duration of intensive care unit (ICU) stay, time after surgery, and the development of POD and cognitive impairment, which are potentially preventable (Crocker et al, ; Phillips‐Bute et al, ).…”