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

Area of Science:

• Neurology
• Psychiatry
• Critical Care Medicine

Background:

• Delirium is a neuropsychiatric disorder characterized by acute changes in attention and awareness.
• While extensively studied in ICUs, its incidence and predictors in stroke units require further investigation.
• This study focuses on the occurrence and risk factors of delirium in acute stroke patients.

Purpose of the Study:

• To determine the incidence of delirium in patients admitted to a stroke unit.
• To identify risk factors associated with delirium development in acute stroke.
• To understand the clinical implications of delirium in this patient population.

Main Methods:

• Consecutive enrollment of 120 acute stroke patients (age ≥18 years, NIHSS ≥1) from April to October 2020.
• Exclusion of transient ischemic attack, non-lesional stroke, cerebral venous thrombosis, subarachnoid hemorrhage, and ICU-level care needs.
• Assessment using Richmond Agitation-Sedation Scale (RASS) and Confusion Assessment Method-Intensive Care Unit (CAM-ICU) at baseline and within 72 hours or upon symptom onset.

Main Results:

• The overall incidence of delirium was 30% (36/120 patients).
• Delirium was significantly associated with aphasia (OR 9.77), COPD (OR 16.67), deep Fazekas score (OR 5.05), and physical restraint (OR 45.02).
• Diabetes mellitus was associated with a reduced incidence of delirium (OR 0.04).

Conclusions:

• Approximately 30% of acute stroke patients experienced delirium, confirming it as a frequent complication.
• Associated factors include speech disorders (aphasia), leukoencephalopathy (deep Fazekas score), COPD, and early physical restraint.
• These findings underscore the importance of monitoring for delirium in stroke patients and identifying associated risk factors for targeted interventions.