Identifying Delirium Early after Stroke: A New Prediction Tool for the Intensive Care Unit

Haight, Taylor; Marsh, Elisabeth B.

doi:10.1016/j.jstrokecerebrovasdis.2020.105219

Cited by 6 publications

(3 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Both premorbid and stroke-specific factors can be predictors of delirium. In our study, among the stroke-specific factors, delirium was associated with impairment of vigilance and orientation, gaze paralysis, aphasia, and early use of physical restraint, as reported in previous literature [29,31]. Also the severity of stroke, expressed as NIHSS score, and prestroke mRS score were associated with delirium, which is in line with previous studies [10].…”

Section: Discussionsupporting

confidence: 92%

“…Furthermore, it is possible to argue that, in our cohort, some delirium cases may have been missed due to the presence of aphasia, which was highly represented in our DRL– subgroup (24/84). Aphasia, attributable to large left hemispheric lesions, has been reported as a predictor of delirium [29]. By contrast, inattention and disorganized thinking, two core features of delirium syndrome, are often difficult to identify in the presence of aphasia [30].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Delirium in acute stroke: A prospective, cross‐sectional, cohort study

Rollo

Callea

Brunetti

et al. 2021

Euro J of Neurology

View full text Add to dashboard Cite

Background and purpose Delirium is a neuropsychiatric disorder of attention and awareness that develops over a short time and fluctuates in severity. Although delirium has been extensively studied in intensive care units, the incidence of delirium in stroke units and its predictors in stroke patients need further investigation. The endpoints of our study were incidence of delirium in acute stroke and the risk factors that predispose to this condition. Methods Patients were consecutively enrolled in a stroke unit from April to October 2020. Inclusion criteria were: age ≥18 years, acute stroke and National Institute of Health Stroke Scale (NIHSS) score ≥1 at the time of clinical assessment of delirium. Exclusion criteria were: transient ischemic attack; absence of neuroimaging evidence of brain lesion; cerebral venous thrombosis; subarachnoid hemorrhage; and clinical conditions requiring intensive care unit treatment. All patients were evaluated by means of Richmond Agitation‐Sedation Scale (RASS) and Confusion Assessment Method‐Intensive Care Unit (CAM‐ICU) scores at baseline, evaluations which were repeated within 72 h or when patients developed symptoms suggesting delirium. Results The overall incidence of delirium was 36/120 (30%). Delirium was associated with aphasia (odds ratio [OR] 9.77; confidence interval [CI] 1.2–79.6), chronic obstructive pulmonary disease (COPD; OR 16.67; CI 1.1–263.0), deep Fazekas score (OR 5.05; CI 1.7–14.8), and physical restraint (OR 45.02; CI 1.4–1411.5). Diabetes was associated with a lower incidence of delirium (OR 0.04; CI 0.026–0.7). Conclusions Nearly one‐third of patients (30%) had delirium in the acute phase of stroke. This finding supports the notion that delirium is a common complication of stroke. Delirium was associated with speech disorder, leukoencephalopathy, COPD and early use of physical restraint.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Delirium in acute stroke: A prospective, cross‐sectional, cohort study

Rollo

Callea

Brunetti

et al. 2021

Euro J of Neurology

View full text Add to dashboard Cite

show abstract

“…В целом остается неясным, какие пропорции гипоактивного или гиперактивного делирия существуют среди больных с нейрокритическими состояниями [22]. Наиболее частыми факторами риска, связанными с развитием делирия после инсульта, были: возраст старше 64 лет; внутрижелудочковое кровоизлияние; интубация; наличие когнитивной дисфункции, афазии или неглекта (синдром игнорирования) и острое повреждение почек [23].…”

Section: неврологические причиныunclassified

Delirium in neurological practice

Dubenko

Nіkonov

2021

ЕМ

View full text Add to dashboard Cite

Delirium is an acute, usually reversible, fluctuating impairment of the level of consciousness, attention, and cognitive activity resulted from impaired brain metabolism due to a wide range of various neurological and non-neurological diseases, the effects of drugs and other substances. The main manifestations of delirium are acute changes in consciousness, disturbance of attention, perception, often with the development of hallucinations, emotion, sleep-wake cycle, psychomotor and autonomic activity. Delirium is divided into hypoactive and hyperactive subtypes depending on the severity of psychomotor and emotional disturbances. Patients with acute stroke are also often susceptible to episodes of delirium at the risk factors such as age, pre-existing cognitive impairment, pneumonia, urinary tract infections, and right hemispheric stroke. The pathophysiology of delirium has been less known, but there is evidence of the role of cholinergic deficiency. Delirium is a transient condition, but it needs treatment to prevent the development of complications since it is usually associated with poor functional outcomes, longer hospitalization and higher mortality. The strategy for the treatment of patients with delirium should be directed to early identification of its symptoms, elimination of modifiable risk factors and metabolic causes. In patients with severe symptoms of agitation and hallucinations, short-term prescription of antipsychotics for their relief is possible.

show abstract