title: Post-stroke delirium in relation to dementia and long-term mortality.
abstract: BACKGROUND
  Delirium is a frequent post-stroke complication that compromises effective rehabilitation and has been associated with poor outcome. We aimed to investigate whether delirium is associated with increased risk of post-stroke dementia and long-term mortality once confounding is taken into account.
  
  
  METHODS
  The study comprised 263 consecutive acute ischemic stroke patients aged 55-85 years admitted to the emergency department of a university hospital. The cohort included three-month survivors followed up for 10 years. The diagnosis of post-stroke delirium during the first 7 days after stroke was based on the DSM-IV criteria.
  
  
  RESULTS
  Of all the patients, 50 (19.0%) were diagnosed with delirium. Low education, pre-stroke cognitive decline, and severe stroke indicated by a Modified Rankin score between 3 and 5 were risk factors for post-stroke delirium, which was also associated with diagnosis of dementia at 3 months post-stroke. In the Kaplan-Meier analysis, delirium was associated with poor long-term survival (6.1 versus 9.1 years). In the stepwise Cox regression proportional hazards analysis adjusted for demographic factors and risk factors, advanced age (hazard ratio [HR] 1.08) and stroke severity (HR 1.83), but not post-stroke delirium, were associated with poor survival.
  
  
  CONCLUSIONS
  In our well-defined cohort of post-stroke patients, acute stage delirium was diagnosed in one in five patients and associated with dementia at 3 months. Advanced age and stroke severity were related to the higher long-term mortality among patients with post-stroke delirium.
authors.affiliation: Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland. susanna.melkas@hus.fi
authors.forename: Susanna
authors.initials: S
authors.lastname: Melkas
authors.forename: Jouko V
authors.initials: JV
authors.lastname: Laurila
authors.forename: Risto
authors.initials: R
authors.lastname: Vataja
authors.forename: Niku
authors.initials: N
authors.lastname: Oksala
authors.forename: Hanna
authors.initials: H
authors.lastname: Jokinen
authors.forename: Tarja
authors.initials: T
authors.lastname: Pohjasvaara
authors.forename: Antero
authors.initials: A
authors.lastname: Leppävuori
authors.forename: Markku
authors.initials: M
authors.lastname: Kaste
authors.forename: Pekka J
authors.initials: PJ
authors.lastname: Karhunen
authors.forename: Timo
authors.initials: T
authors.lastname: Erkinjuntti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003693:Delirium / Q000453:epidemiology / Q000209:etiology*; D003704:Dementia / Q000209:etiology*; D004522:Educational Status; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000401:mortality