Incidence of post-stroke delirium and 1-year outcome

Post-stroke delirium is not uncommon, and is associated with poorer outcome, higher mortality, longer hospital stay and greater risk of post-stroke dementia. We aim to identify the incidence of post-stroke delirium, risk factors for its development and 1-year outcome.

Consecutive patients aged >50 years admitted to the acute stroke unit were recruited. Baseline demographic data, types of stroke, location of infarct, etiology of stroke, premorbid cognitive impairment, living arrangement, comorbidity, drug history and biochemical parameters were collected. Delirium was screened by the Confusion Assessment Method. Outcome data included length of stay, mortality, functional mobility, and placement on discharge 6 months and 12 months post-stroke.

A total of 314 patients with a mean age of 72.9 years were recruited. Of those patients, 86 (27.4%) had delirium. Age (OR 1.05), presence of acute urinary retention (OR 7.67), chest infection (OR 22), National Institutes of Health Stroke Scale (OR 1.13), total anterior circulation infarct (OR 18.8), posterior circulation infarct (OR 3.52) and pre-existing cognitive impairment (OR 2.51) were independent predictors of post-stroke delirium. Patients with delirium had more functional disability, a higher proportion went to a nursing home on discharge (62% vs 11.2%), at 6 months (60% vs 12.5%) and at 12 months (65% vs 13%), and there was higher inpatient mortality (18% vs 2.2%) and 1-year mortality (30% vs 7.4%). Hospital stay was also longer (45 vs 22 days).

Delirium is a common complication post-stroke, with treatable risk factors. It results in higher functional impairment, nursing home placement and mortality. Comprehensive geriatric assessment of older stroke patients might help to reduce the occurrence of delirium.