Delirium within three days of stroke in a cohort of elderly patients.
OBJECTIVE
To evaluate the incidence of stroke, risk factors for stroke, and outcomes in elderly stroke patients with delirium.


METHODS
Cohort study with 12-month follow-up.


METHODS
Bankstown-Lidcombe Hospital, a 450-bed teaching hospital of the University of New South Wales, Sydney, Australia.


METHODS
One hundred fifty-six stroke patients aged 65 and older recruited over 1 year.


METHODS
Incidence of delirium (defined in accordance with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria) within 3 days poststroke, length of hospital stay, discharge destination, short- and long-term mortality, Functional Independence Measure (FIM) scores, and Mini-Mental State Examination (MMSE) scores.


RESULTS
Thirty-nine (25%) elderly stroke patients had delirium within 3 days after stroke. Logistic regression analysis found that older age (P=.04), hemorrhagic stroke (P=.02), metabolic disorders (P=.003), dementia prestroke (P=.02), Glasgow Coma Scale (GCS) score less than 15 on admission (P<.001), and inability to lift both arms on admission (P=.03) were independent predisposing factors for delirium. Patients who had a cardioembolic stroke (odds ratio (OR)=5.58) or total anterior circulation infarction (OR=3.42) were also more likely to develop delirium. Patients with delirium were associated with higher 6- and 12-month mortality (P<.05), lower 12-month FIM and MMSE scores, and a higher 12-month institutionalization rate.


CONCLUSIONS
Delirium occurred frequently in acute stroke patients aged 65 and older. Factors independently associated with delirium included old age, intracerebral hemorrhage, metabolic factors, prestroke dementia, initial GCS less than 15, and inability to lift both arms on admission. Patients with delirium had higher long-term mortality and a worse functional outcome.
Sheng
Ai Zhen
AZ
Department of Aged Care and Rehabilitation, Bankstown-Lidcombe Hospital, Sydney, Australia. shengaizhen@hotmail.com
Shen
Qing
Q
Cordato
Dennis
D
Zhang
Yun Yun
YY
Yin Chan
Daniel Kam
DK
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000453:epidemiology; D015996:Survival Rate; D013997:Time Factors