Delirium in acute stroke: A predictor of subsequent cognitive impairment?

Rijsbergen, Mariëlle W.A. van; Oldenbeuving, Annemarie W.; Mark, Ruth E.; Nys, G.M.S.; Las, Sylvia G.M.; Roks, Gerwin; Kort, Paul L.M. de

doi:10.1016/j.jns.2011.03.024

Cited by 30 publications

(49 citation statements)

References 37 publications

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“…Indeed, though several of the aforementioned retrospective studies in stroke patients did note that delirium was associated with longer hospitalizations and short-term functional impairments, only one found that delirium was independently associated with impairment in long-term cognitive outcomes. [35] In our study, meanwhile, patients with agitation had a persistent long-term impairment in IADLs even after controlling for the effects of hospital complications. Whether agitation itself is associated with long-term outcomes is a question worthy of further investigation in prospective studies; it is also unclear what effect the various approaches to treating agitation may have on outcomes.…”

Section: Discussionmentioning

confidence: 50%

Agitation After Subarachnoid Hemorrhage: A Frequent Omen of Hospital Complications Associated with Worse Outcomes

et al. 2016

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Purpose Agitated delirium is frequent following acute brain injury, but data are limited in patients with subarachnoid hemorrhage (SAH). We examined incidence, risk factors, and consequences of agitation in these patients in a single-center retrospective study. Methods We identified all patients treated with antipsychotics or dexmedetomidine from a prospective observational cohort of patients with spontaneous SAH. Agitation was confirmed by chart review. Outcomes were assessed at 12 months using the modified Rankin Scale (mRS), Telephone Interview for Cognitive Status (TICS), and Lawton-IADL (Instrumental Activities of Daily Living) score. Independent predictors were identified using logistic regression. Results From 309 SAH patients admitted between 1/2011 and 12/2015, 52 (17%) developed agitation, frequently in the first 72 hours (50%) and in patients with Hunt-Hess grades 3–4 (12% of grades 1–2, 28% of grades 3–4, 8% of grade 5). There was also a significant association between agitation and a history of cocaine use or prior psychiatric diagnosis. Agitated patients were more likely to develop multiple hospital complications, and in half of these patients complications were diagnosed within 24 hours of agitation onset. Agitation was associated with IADL impairment at 12 months (Lawton >8; p = 0.03, OR 2.7, 95% CI 1.1–6.8) in non-comatose patients (Hunt-Hess 1–4), but not with functional outcome (mRS >3), cognitive impairment (TICS ≤30), or ICU/hospital length of stay after controlling for other predictors. Conclusion Agitation occurs frequently after SAH, especially in non-comatose patients with higher clinical grades. It is associated with the development of multiple hospital complications, and may have an independent impact on long-term outcomes.

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Section: Discussionmentioning

confidence: 50%

Agitation After Subarachnoid Hemorrhage: A Frequent Omen of Hospital Complications Associated with Worse Outcomes

et al. 2016

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“…Therefore, the cut-off values that were chosen may be considered subjective. Since delirium after stroke has a worse prognosis,3 6 it is important to detect these patients as early as possible. Hence, for the risk table (table 4), we have chosen a relatively low cut-off value of 20%, as a high risk of delirium after stroke.…”

Section: Discussionmentioning

confidence: 99%

“…Delirium after stroke is associated with a higher mortality, a worse functional outcome and an increased risk of institutionalisation 3 5. Moreover, it is an independent predictor for severe cognitive impairment after 2 years 6. Age, pre-existent cognitive decline, severe neurological deficits and medical complications are the most important risk factors 4 7 8.…”

Section: Introductionmentioning

confidence: 99%

An early prediction of delirium in the acute phase after stroke

Oldenbeuving

Kort

Sluijs

et al. 2013

Journal of Neurology, Neurosurgery & Psychiatry

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“…Compared to non-delirious stroke patients, delirious patients have worse functional outcome after the stroke [3, 4] and lower quality of life one-month after hemorrhagic stroke [5]. Patients who are delirious in the acute phase of stroke have lower score in Mini Mental State Examination 1, 6 and 12 months after the stroke [6] and increased risk for dementia two years after the stroke [7]. …”

Section: Introductionmentioning

confidence: 99%

PRospective Observational POLIsh Study on post-stroke delirium (PROPOLIS): methodology of hospital-based cohort study on delirium prevalence, predictors and diagnostic tools

Klimiec

Dziedzic

Kowalska³

et al. 2015

BMC Neurol

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BackgroundBetween 10 % to 48 % of patients develop delirium in acute phase of stroke. Delirium determinants and its association with other neuropsychiatric disturbances in stroke are poorly understood. The wildly accepted predictive model of post-stroke delirium is still lacking.Methods/designThis is a prospective, observational, single-center study in patients with acute phase of stroke. We aim to include 750 patients ≥18 years with acute stroke or transient ischemic attack admitted to the stroke unit within 48 hours after stroke onset. The goals of the study are: 1) to determine frequency of delirium and subsyndromal delirium in Polish stroke patients within 7 days after admission to the hospital; 2) to determine factors associated with incidence, severity and duration of delirium and subsyndromal delirium and to create a predictive model for post-stroke delirium; 3) to determine the association between delirium and its cognitive, psychiatric, behavioral and functional short and long-term consequences; 4) to validate scales used for delirium diagnosis in stroke population.Patients will be screened for delirium on daily basis. The diagnosis of delirium will be based on DSM-V criteria. Abbreviated version of Confusion Assessment Method and Confusion Assessment Method for the Intensive Care Unit will be used for delirium and sub-delirium screening. Severity of delirium symptoms will be assessed by Delirium Rating Scale Revised 98 and Cognitive Test for Delirium. Patients who survive will undergo extensive neuropsychological, neuropsychiatric and functional assessment 3 and 12 months after the stroke.DiscussionThis study is designed to provide information on clinical manifestation, diagnostic methods and determinants of delirium spectrum disorders in acute stroke phase and their short and long-term consequences. Collected information allow us to create a predictive model for post-stroke delirium.

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Delirium in acute stroke: A predictor of subsequent cognitive impairment?

Cited by 30 publications

References 37 publications

Agitation After Subarachnoid Hemorrhage: A Frequent Omen of Hospital Complications Associated with Worse Outcomes

Agitation After Subarachnoid Hemorrhage: A Frequent Omen of Hospital Complications Associated with Worse Outcomes

An early prediction of delirium in the acute phase after stroke

PRospective Observational POLIsh Study on post-stroke delirium (PROPOLIS): methodology of hospital-based cohort study on delirium prevalence, predictors and diagnostic tools

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