Impact of delirium on the outcome of stroke: a prospective, observational, cohort study

Abstract

Introduction Delirium is an acute fluctuating disorder of attention and awareness, which often complicates the clinical course of several conditions, including acute stroke. The aim of the present study was to determine whether delirium occurrence impacts the outcome of patients with acute stroke. Methods The study design is single center, prospective, observational. We consecutively enrolled patients admitted to the stroke unit from April to October 2020. Inclusion criteria were age ≥ 18 years and diagnosis of acute stroke. Exclusion criteria were stroke mimics, coma, and terminal conditions. All patients were screened for delirium upon admission, within 72 h, and whenever symptoms suggesting delirium occurred by means of the Confusion Assessment Method for Intensive Care Unit and the Richmond Agitation Sedation Scale. Outcomes were evaluated with the 90-days modified Rankin Scale (mRS) by telephone interview. Results The final study cohort consisted of 103 patients (62 men; median age 75 years, interquartile range 63–81). Thirty-one patients (30%) developed delirium. In the multivariate ordinal logistic regression, patients with delirium had higher mRS scores at 3 months (DLR + : mRS = 4 (3–6); DLR–: mRS = 1 (1–3); adjusted odds ratio = 4.83; CI = 1.88–12.35; p = 0.006). Delirium was a risk factor for death (mRS = 6) in the univariate logistic regression (OR 4.5, CI = 1.44–14.07; p = 0.010), but not in the adjusted analysis (OR 3.45; CI = 0.66–17.95; p = 0.142). Survival time during 90-days follow-up was shorter in the delirium group (Log Rank χ2 3.89; p = 0.048). Conclusion Delirium negatively impacts the prognosis of patients with acute stroke. Patients with post-stroke delirium have a worse functional outcome and a shorter survival.

Development of insomnia in patients with stroke: A systematic review and meta-analysis

“…This study found that the prevalence of insomnia using the Insomnia Assessment Diagnostic Tool was 51.16%, which was higher than the prevalence of self-reported insomnia (37.58%). In contrast, in study using the insomnia assessment and diagnostic tool, the prevalence of insomnia was different in acute phase and subacute phase stroke (32.5% vs 34.8%), whereas the overall prevalence of self-assessed insomnia also was different in acute phase and subacute phase stroke (47.1% vs 50.4%) [ 52 ]. Further large-sample studies are needed to validate these findings.…”

Five-year stroke prognosis. Influence of post-stroke delirium and post-stroke dementia on mortality and disability (Research Study – Part of the PROPOLIS Study)

“…Shi et al in 2012 summarized in their meta-analysis that post-stroke delirium was associated with higher one-year mortality [ 37 ], and these results have also been confirmed by subsequent authors [ 38 , 39 ]. Although the negative impact of post-stroke delirium on functional disability is known [ 38 , 40 ], long-term data were still lacking.…”

Sleep and Stroke: Opening Our Eyes to Current Knowledge of a Key Relationship

“…When evaluating self-reported insomnia symptoms by means of questionnaires, the summary prevalence was 47.1% in the acute phase, and 50.4% in the subacute phase [1••]. However, it is worth to consider that insomnia is a multifactorial disorder, where a big contribution to sleep disruption is played by the hospital setting; importantly, sleep fragmentation in acute stroke is associated with an increased risk for stroke-associated delirium [112] that is, in turn, associated to poorer long-term outcome [113]. Nonetheless, studies in which insomnia was evaluated at different time points, up to 18 months from stroke onset, revealed a prevalence of insomnia symptoms near to 50% [114,115].…”