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

Abstract

<jats:p>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.</jats:p>

Transient cognitive impairment in the acute phase of stroke – prevalence, risk factors and influence on long-term prognosis in population of patients with stroke (research study – part of the PROPOLIS study)

“…At follow-up outpatient visits, patients underwent neuropsychological testing. The details of cognitive evaluation were described elsewhere [23]. Adverse prognosis was defined as the occurrence of any of the following: death, increase in mRS score by ≥1 (between pre-hospital and follow-up visit), hospital or institution stay, and dementia.…”

Current view on post‐stroke dementia

“…Ojagbemi and Ffytche presented a meta‐analysis suggesting a decrease in post‐stroke cognitive functions in patients with delirium in the acute phase of stroke, however, the evidence level of this result was estimated as low 38 . While these results have been confirmed in a few subsequent studies, 39,40 there is still a need for further research with the use of well‐defined cohorts of patients.…”

Associations of Delirium to Posthospital Outcomes After Acute Stroke: A Scoping Review

“…9,17,24 Timing of outcome assessment ranged from 1 month 17 to 2 years, 17 with 2 studies instituting a longitudinal design to assess cognitive outcomes over multiple time points. 17,22 Among patients with AIS and ICH, delirium seems to be associated with greater posthospital cognitive impairment, 9,16,17,22,24 even after controlling for relevant variables such as age, sex, 22,24 education, 22 stroke location and severity, and aphasia. 22 Ojagbemi and Ffytche 16 conducted a systematic review to assess whether acute stroke survivors who experience delirium are at a higher risk of cognitive impairment.…”

“…Four primary studies 9,17,22,24 and 1 systematic review 16 (n = 1799) explored the association of delirium with posthospital cognition after acute stroke (Table 1). Sample sizes ranged from 150 patients 24 to 750patients.…”

“…All studies excluded patients with subarachnoid hemorrhage (SAH). 9,16,17,22,24 All except 1 study 17 were prospective studies. Delirium assessment methods, outcome measures, and outcome assessment timing varied across studies.…”