Delirium within Three Days of Stroke in a Cohort of Elderly Patients

Abstract

Delirium occurred frequently in acute stroke patients aged 65 and older. Factors independently associated with delirium included old age, intracerebral hemorrhage, metabolic factors, prestroke dementia, initial GCS less than 15, and inability to lift both arms on admission. Patients with delirium had higher long-term mortality and a worse functional outcome.

Prevalence for delirium in stroke patients: A prospective controlled study

“…In other studies, duration of delirium was in mean 4 days (Dostovic, Smajlovic, Sinanovic, & Vidovic, 2009;Mitasova et al, 2012) or 4.8 days (Oldenbeuving et al, 2011) and delirious episodes ≤24 hr were reported in 25% (Mitasova et al, 2012) to 46% (Sheng, Shen, Cordato, & Zhang, 2006). This phenomenon in patients with an acute stroke might be caused by cerebral dysregulation and associated with reduced perfusion, hypoxia, and disturbed neurotransmitters (Maldonado, 2008).…”

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].…”

“…There was no attempt in any of the studies to assess the suitability of using a generic delirium screening tool in acute stroke. A number of studies considered the challenge of using the above tools in acute stroke, as ten studies reported excluding patients with reduced consciousness [23,27,29,30,32,33,[36][37][38][39] and four studies excluded patients with aphasia [24,26,29,36]. Caeiro et al reported scoring zero in certain items of the DRS if patients had "language difficulties" [23,31,32], however, this term is somewhat vague.…”

“…Due to this, we report only the results of the random effects approach: incidence of delirium was 26% with a 95% confidence interval of 19%-33%. The frequency of delirium assessment also varied: Ten studies applied diagnostic procedures once within the first week of admission [23,24,26,28,31,32,[36][37][38][39] and 3 studies applied these more than once daily [29,30,38] with the rest of the studies not reporting on the time points at which delirium assessments were carried out (table 2).…”

“…The most frequently cited risk factors for developing delirium in the acute stage of stroke were: older age[2, 23,26,27,29,30,32]; specific symptoms resultant from the stroke (aphasia, neglect or dysphagia) [23,26,27,31,32,38]; impaired vision [25][26][27]38], either as a result of the stroke or pre-morbid visual disturbance, elevated cortisol levels [28,29,37] and drugs with anticholinergic effect [30,31]. Eight studies (n=209 with delirium) reported the association between lesion location and development of delirium: three studies found an association between right sided lesions [33,36,44] and two for left sided lesions [30,34].…”