Delirium Post-Stroke: Short- and Long-Term Effect on Depression, Anxiety, Apathy and Aggression (Research Study—Part of PROPOLIS Study)

Kowalska, Katarzyna; Droś, Jakub; Mazurek, Małgorzata; Pasińska, Paulina; Gorzkowska, Agnieszka; Klimkowicz‐Mrowiec, Aleksandra

doi:10.3390/jcm9072232

Cited by 20 publications

(16 citation statements)

References 43 publications

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“…This would imply that the anxiety levels in patients with delirium are of clinical importance at 18 and 36 months (Mean ( SD ): 5.6 (1.2) and 6.2 (1.3) respectively). Though Kowalska et al [ 54 ] recently found delirium to be a risk factor for anxiety 3 months after stroke, our findings suggest that the subsequent anxiety symptoms can be present or even increase over a longer timeframe.…”

Section: Discussioncontrasting

confidence: 80%

The relationship of acute delirium with cognitive and psychiatric symptoms after stroke: a longitudinal study

et al. 2022

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Objective Delirium, a common complication after stroke, is often overlooked, and long-term consequences are poorly understood. This study aims to explore whether delirium in the acute phase of stroke predicts cognitive and psychiatric symptoms three, 18 and 36 months later. Method As part of the Norwegian Cognitive Impairment After Stroke Study (Nor-COAST), 139 hospitalized stroke patients (49% women, mean (SD) age: 71.4 (13.4) years; mean (SD) National Institutes of Health Stroke Scale (NIHSS) 3.0 (4.0)) were screened for delirium with the Confusion Assessment Method (CAM). Global cognition was measured with the Montreal Cognitive Assessment (MoCA), while psychiatric symptoms were measured using the Hospital Anxiety and Depression Scale (HADS) and the Neuropsychiatric Inventory-Questionnaire (NPI-Q). Data was analyzed using mixed-model linear regression, adjusting for age, gender, education, NIHSS score at baseline and premorbid dementia. Results Thirteen patients met the criteria for delirium. Patients with delirium had lower MoCA scores compared to non-delirious patients, with the largest between-group difference found at 18 months (Mean (SE): 20.8 (1.4) versus (25.1 (0.4)). Delirium was associated with higher NPI-Q scores at 3 months (Mean (SE): 2.4 (0.6) versus 0.8 (0.1)), and higher HADS anxiety scores at 18 and 36 months, with the largest difference found at 36 months (Mean (SE): 6.2 (1.3) versus 2.2 (0.3)). Conclusions Suffering a delirium in the acute phase of stroke predicted more cognitive and psychiatric symptoms at follow-up, compared to non-delirious patients. Preventing and treating delirium may be important for decreasing the burden of post-stroke disability.

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Section: Discussioncontrasting

confidence: 80%

The relationship of acute delirium with cognitive and psychiatric symptoms after stroke: a longitudinal study

et al. 2022

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“…Their verbal behavior may include cursing, screaming, or hostile muttering. In some cases, these behaviors are one of the broad manifestations of delirium [ 4 ] that include disturbances in attention, awareness, and cognition. Studies have also described a so-called “catastrophic reaction,” [ 5 , 6 ] which is a constellation of symptoms including anxiety reactions, tears, aggressive behavior, refusal, and swearing [ 5 ].…”

Section: Anger As a Results Of Strokementioning

confidence: 99%

“…Moreover, these behaviors generally subside over time along with the disappearance of other delirious or aphasic symptoms. 4,5 Thus, the aggressive behaviors shown in these patients are unlikely to be an anger based on true emotion disturbances.…”

Section: Phenomenology and Terminologymentioning

confidence: 90%

Anger, a Result and Cause of Stroke: A Narrative Review

Choi-Kwon

Kim

2022

J Stroke

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Post-stroke mood and emotional disturbances are frequent and diverse in their manifestations. Among them, post-stroke depression is the best known. Although post-stroke anger (PSA) has been studied relatively less, it can be as frequent as depression. Manifestations of PSA range from overt aggressive behaviors (including hitting or hurting others) to becoming irritable, impulsive, hostile, and less tolerable to family members. The possible pathophysiological mechanisms of PSA include neurochemical dysfunction due to brain injury, frustration associated with neurological deficits or unfavorable environments, and genetic predisposition. PSA causes distress in both patients and their caregivers, negatively influences the patient’s quality of life, and increases the burden on caregivers. It can be treated or prevented using various methods, including pharmacological therapies. In addition, anger or hostility may also be a risk or triggering factor for stroke. The hazardous effects of anger may be mediated by other risk factors, including hypertension or diabetes mellitus. The identification of anger as a result or cause of stroke is important because strategic management of anger may help improve the patient’s quality of life or prevent stroke occurrence. In this narrative review, we describe the phenomenology, prevalence, factors or predictors, relevant lesion locations, and pharmacological treatment of PSA. We further describe the current evidence on anger as a risk or triggering factor for stroke.

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“…48 The pooled prevalence of post-stroke depression was estimated at approximately 30%, but the results from single studies have varied from 5% to 84%. [49][50][51] Depression occurs most frequently over a short period following the acute phase of stroke, and the percentage of remission is significant. However, high rates of recurrence and new cases are observed, even after a long period following a stroke.…”

Section: Association With Depressionmentioning

confidence: 99%

Current view on post‐stroke dementia

Droś

Klimkowicz‐Mrowiec

2021

Psychogeriatrics

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Dementia is one of the leading complications after stroke affecting about one third of survivors. Prevalence of post‐stroke dementia (PSD) differs between studies due to variability in methodology, characteristics of included patients, type of stroke, diagnostic tools used to identify patients with dementia, or time when the assessment was performed. Patients diagnosed with PSD are at higher risk of mortality, disability, and institutionalization. Aetiology of PSD may include mixed overlapping processes such as vascular brain pathology or Alzheimer's disease. Several risk factors have been found to increase PSD incidence, involving demographics, vascular factors, stroke characteristics, abnormalities on neuroimaging, and stroke complications. However, the influence of some other factors still remains unclear. PSD may coexist with other neuropsychiatric disorders and its association with post‐stroke depression seems to be the most significant. There is a strong need for further research on possible genetic, biological, and inflammatory biomarkers. Also, there are no unambiguously efficacious methods of management. Continuing to address these issues will help to find more effective interventions directly targeting prevention and treatment of PSD in the future.

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Delirium Post-Stroke: Short- and Long-Term Effect on Depression, Anxiety, Apathy and Aggression (Research Study—Part of PROPOLIS Study)

Cited by 20 publications

References 43 publications

The relationship of acute delirium with cognitive and psychiatric symptoms after stroke: a longitudinal study

The relationship of acute delirium with cognitive and psychiatric symptoms after stroke: a longitudinal study

Anger, a Result and Cause of Stroke: A Narrative Review

Current view on post‐stroke dementia

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