Delirium in the first days of acute stroke.
OBJECTIVE
Delirium is an acute, transient disorder of cognition and consciousness with fluctuating intensity. The aim of this study was to investigate the presence and the risk factors for delirium in the first days after stroke onset.


METHODS
We assessed delirium prospectively in a sample of 218 consecutive patients (mean age 57 years) with an acute (</= 4 days) stroke (28 subarachnoid haemorrhages, 48 intracerebral haemorrhages, 142 cerebral infarcts) and in a control group of 50 patients with acute coronary syndromes with the Delirium Rating Scale (DRS) (cut-off score >/= 10).


RESULTS
29 (13%) acute stroke patients (mean DRS score = 13.2, SD = 2.3) and only one (2 %) acute coronary patient had delirium (chi(2) = 5.2, p = 0.02). In nine patients delirium was secondary to stroke without any additional cause, in 10 patients there were also medical complications and in the remaining 10 there were multiple potential causes for delirium. Delirium was more frequent after hemispherical than after brainstem/cerebellum strokes (p = 0.02). No other statistically significant associations with stroke locations were found. Medical complications (OR = 4.3; 95% CI = 1.8 to 10.2), neglect (OR = 3.5; 95% CI = 1.3 to 9.2), intracerebral haemorrhage (OR = 3.1; 95% CI = 1.3 to 7.5) and age >/= 65 (OR = 2.4; 95% CI = 1.0 to 5.8) were independent factors to the development of delirium in stroke patients.


CONCLUSIONS
Delirium was more frequent in stroke than in coronary acute patients. Among stroke patients, delirium was most frequent in older patients, in those with neglect, with medical complications and with intracerebral haemorrhages. These findings indicated that delirium in acute stroke patients 1) is not a non-specific consequence of acute disease and hospitalisation and 2) is secondary to hemisphere brain damage and to metabolic disturbances due to medical complications.
Stroke Unit, Serviço de Neurologia, Centro de Estudos de Egas Moniz, Hospital de Santa Maria, 1649-035, Lisboa, Portugal.
Lara
L
Caeiro
José M
JM
Ferro
Rodolfo
R
Albuquerque
M Luísa
ML
Figueira
D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D020526:Brain Stem Infarctions / Q000150:complications / Q000503:physiopathology; D015984:Causality; D002543:Cerebral Hemorrhage / Q000150:complications / Q000503:physiopathology; D002544:Cerebral Infarction / Q000150:complications / Q000503:physiopathology; D003327:Coronary Disease / Q000150:complications / Q000503:physiopathology; D003693:Delirium / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008659:Metabolic Diseases / Q000150:complications / Q000503:physiopathology; D008875:Middle Aged; D010468:Perceptual Disorders / Q000150:complications / Q000503:physiopathology; D011446:Prospective Studies; D020521:Stroke / Q000150:complications* / Q000503:physiopathology