Delirium Post-Stroke-Influence on Post-Stroke Dementia (Research Study-Part of the PROPOLIS Study).

BACKGROUND: Previous research confirmed association between delirium and subsequent dementia in different clinical settings, but the impact of post-stroke delirium on cognitive functioning is still under-investigated. Therefore, we aimed to assess the risk of dementia among patients with stroke and in-hospital delirium. METHODS: A total of 750 consecutive patients admitted to the stroke unit with acute stroke or transient ischemic attacks were screened for delirium, during the first seven days after admission. At the three- and twelve-month follow-up, patients underwent cognitive evaluation. The DSM-5 definition for dementia was used. Cases with pre-stroke dementia were excluded from the analysis. RESULTS: Out of 691 included cases, 423 (61.22%) and 451 (65.27%) underwent cognitive evaluation, three and twelve months after stroke; 121 (28.61%) and 151 (33.48%) patients were diagnosed with dementia, respectively. Six (4.96%) patients with dementia, three months post-stroke did not meet the diagnostic criteria for dementia nine months later. After twelve months, 37 (24.50%) patients were diagnosed with dementia, first time after stroke. Delirium in hospital was an independent risk factor for dementia after three months (OR = 7.267, 95%CI 2.182-24.207, p = 0.001) but not twelve months after the stroke. CONCLUSIONS: Patients with stroke complicated by in-hospital delirium are at a higher risk for dementia at three but not twelve months post-stroke.

The long-term prognosis of patients with delirium in the acute phase of stroke: PRospective Observational POLIsh Study (PROPOLIS).

BACKGROUND AND PURPOSE: Delirium is a very common neurobehavioral complication after stroke, but its influence on long-term outcome is not well characterized. The objective of the study was to determine the prognostic significance of delirium for functional status, nursing home admission, and mortality in a large cohort of patients with delirium in the acute phase of stroke assessed 3 and 12 months after stroke. METHODS: All stroke survivors included in PROPOLIS were followed up (n = 682). Outcome data included: discharge destination, recurrence of stroke, cardiovascular complications, functional activity and mobility, nursing home admission, and mortality. RESULTS: Patients with delirium were discharged to another hospital or nursing home significantly more often than those presenting without delirium. The 3- and 12-month post-stroke mortality rates were higher in delirious patients (OR 6.41 CI 3.76-10.92; p < 0.001 and OR 5.17 CI 3.36-7.96; p < 0.001). When considering 3-month mortality, higher age, modified Rankin Scale prior to admission and temperature between 1 and 3 days after admission, as well delirium, pneumonia and more severe neurological deficits on admission were independent risk factors. For 12-month mortality, the independent risk factors were higher age and modified Rankin Scale post-stroke, delirium, and history of respiratory diseases prior to stroke. Patients with delirium were more likely to live in nursing homes 3 and 12 months after stroke and were more disabled than patients without delirium. CONCLUSIONS: Delirium in acute phase of stroke negatively influences the long-term prognosis. A study addressing the effect of early recognition and treatment of identified modifiable risk factors for adverse long-term outcomes is urgently needed to decrease bad prognosis within this population.

Poststroke Delirium Clinical Motor Subtypes: The PRospective Observational POLIsh Study (PROPOLIS).

OBJECTIVE: Although delirium is the most common neurobehavioral complication after stroke, its motor subtypes-hypoactive, hyperactive, mixed, and none-as well as their risk factors are not well characterized. Motor subtypes influence recognition and prognosis of delirium in hospitalized patients. METHODS: The aim of this prospective study was to assess the frequency of poststroke delirium subtypes and to describe their predictive models. Consecutive patients with stroke were screened for delirium with the Confusion Assessment Method for the Intensive Care Unit. Delirium was diagnosed according to DSM-5 criteria, and subtypes were classified with the Delirium Motor Subtype Scale-4. Baseline demographic characteristics, biochemistry, stroke-related data, medications, neurological deficits, and premorbid cognitive and functional impairments were assessed. RESULTS: Out of 750 patients (mean age, 71.75 years [SD=13.13]), 203 (27.07%) had delirium: 85 (11.34%) were hypoactive, 77 (10.27%) were mixed hypoactive-hyperactive, 31 (4.13%) were hyperactive, and 10 (1.33%) had an unspecified type. Cognitive impairment at the time of hospital admission and spatial neglect, among other factors, were identified as the best predictors for all motor delirium subtypes. CONCLUSIONS: Screening for poststroke delirium is important because the hypoactive subtype bears the worst prognosis and is misdiagnosed the most compared with other subtypes. All identified factors for the predictive models of delirium subtypes are routinely assessed during hospital admission. Their occurrence in patients with stroke should alert the treating physician to the high risk for a particular delirium subtype.