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Associations Between Stroke Localization and Delirium: A Systematic Review and Meta-Analysis
John Y Rhee1, Mia A Colman2, Maanasa Mendu2
1Department of Neurology, Department and institution where the work was performed, Massachusetts General Hospital, 55 Fruit St., MWEL/Their 423, Boston, MA 02114, USA; Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.
Delirium is common after acute stroke, particularly with supratentorial, anterior circulation, and cortical lesions. Hemorrhagic strokes and pre-existing atrophy also increase delirium risk, aiding in early identification and management.
Area of Science:
- Neurology
- Neuroscience
- Critical Care Medicine
Background:
- Delirium frequently complicates acute stroke, leading to poorer patient outcomes.
- Identifying specific stroke characteristics associated with delirium is crucial for risk stratification and management.
Purpose of the Study:
- To systematically review and synthesize evidence on stroke locations and types associated with delirium in acute stroke patients.
- To identify specific neuroanatomical regions and stroke etiologies linked to increased delirium incidence.
Main Methods:
- Systematic review of studies published between January 2010 and June 2021, including papers in any language.
- Exclusion of case studies with <20 patients, case-control studies, and randomized controlled trials.
- Pooled relative risks calculated using bivariate random effects models or network meta-analysis, with methodological quality assessment.
Main Results:
- Delirium was more prevalent with supratentorial (RR 2.01), anterior circulation (RR 1.41), and cortical lesions (RR 1.54).
- Hemorrhagic strokes (RR 1.74) and pre-existing qualitative atrophy (RR 1.66) were associated with higher delirium rates.
- No significant association was found between stroke side (right vs. left) and delirium (RR 0.99).
Conclusions:
- Specific brain lesion locations (supratentorial, anterior, cortical) and stroke types (hemorrhagic) are significantly associated with delirium.
- These findings can help anticipate delirium risk in acute stroke patients.
- Results highlight potential brain networks and pathologies involved in delirium pathophysiology, despite study heterogeneity.
