Delirium in Acute Stroke

Abstract

Background and Purpose-Delirium is common in the early stage after hospitalization for an acute stroke. We conducted a systematic review and meta-analysis to evaluate the outcomes of acute stroke patients with delirium. Methods-We searched MEDLINE, EMBASE, CINAHL, Cochrane Library databases, and PsychInfo for relevant articles published in English up to September 2011. We included observational studies for review. Two reviewers independently assessed studies to determine eligibility, validity, and quality. The primary outcome was inpatient mortality and secondary outcomes were mortality at 12 months, institutionalization, and length of hospital stay. Results-Among 78 eligible studies, 10 studies (nϭ2004 patients) met the inclusion criteria. Stroke patients with delirium had higher inpatient mortality (OR, 4.71; 95% CI, 1.85-11.96) and mortality at 12 months (OR, 4.91; 95% CI, 3.18 -7.6) compared to nondelirious patients. Patients with delirium also tended to stay longer in hospital compared to those who did not have delirium (mean difference, 9.39 days; 95% CI, 6.67-12.11) and were more likely to be discharged to a nursing homes or other institutions (OR, 3.39; 95% CI, 2.21-5.21). Conclusions-Stroke patients with development of delirium have unfavorable outcomes, particularly higher mortality, longer hospitalizations, and a greater degree of dependence after discharge. Early recognition and prevention of delirium may improve outcomes in stroke patients. (Stroke. 2012;43:645-649.)

Longitudinal Effect of Stroke on Cognition: A Systematic Review

“…Mixed findings may be related to differences in the cognitive tests used and test timing, history of previous stroke, stroke location, large‐ and small‐vessel disease, population sample (clinical versus population based), ethnicity, and the presence of neurodegenerative pathology 9. Nevertheless, it is also possible that the initial poststroke cognitive state may reflect prestroke cognitive decline10 or delirium 11. There is a drive toward detecting long‐term cognitive outcomes after stroke to explore prevention; however, a preferred testing strategy is lacking, making cross‐study comparison difficult 12…”

Prevalence for delirium in stroke patients: A prospective controlled study

“…The prevalence of delirium in patients after stroke is estimated to average 26% (Carin-Levy, Mead, Nicol, Rush, & van Wijck, 2012). A delirium increases the risks for mortality, complications, longer length of hospital stay, and institutionalization (Shi, Presutti, Selchen, & Saposnik, 2012).…”

Delirium: actualización en manejo no farmacológico

“…No sólo está asociado a una alta morbilidad, sino que además presenta un riesgo de 2 a 4 veces mayor de mortalidad durante la hospitalización y al alta médica [2][3][4][5][6] , asociado a un aumento en el riesgo de deterioro cognitivo permanente y demencia a futuro 9 . Involucra a múltiples especialidades, presentándose en pacientes con patologías neurológicas, psiquiátricas, neuroquirúrgicas, médicas, entre otras, con prevalencias que fluctúan entre 7 a 50% e incidencias de 10 a 82% 10 . Demanda un alto costo hospitalario, evidenciándose un 38,7% más de gastos al compararlos con cohortes de pacientes hospitalizados que no presentan delirium 11,12 , correspondiendo a costos que superan los $ 164 billones de dólares por año en Estados Unidos 13 .…”