Stroke severity predicts poststroke delirium and its association with dementia: Longitudinal observation from a low income setting.
OBJECTIVE
The effect of delirium on stroke outcome has not been quantified in sub-Saharan Africa. We investigated the prevalence of delirium occurring within one week of stroke in Nigerian survivors and its association with dementia and mortality at 3months.


METHODS
Delirium was ascertained after repeated assessments within one week of stroke using the Confusion Assessment Method. Demographic and clinical characteristics, stroke severity, current and pre-morbid cognitive functioning were also assessed. Participants were then followed up for 3months using culturally-validated neuropsychological tools. Probable dementia was ascertained according to the National Institute of Neurological Disorders and Stroke (NINDS-AIREN) criteria. Associations were investigated using both binomial and multinomial logistic regression analyses and presented as odds ratios (O.R) and relative risk ratios (RRR).


RESULTS
Of 101 consenting stroke survivors, 99 had two assessments for delirium within one week of the stroke. Delirium was present in 33.3% of stroke survivors (65.6% hypoactive, 21.9% hyperactive, and 12.1% mixed type). Having a severe stroke was associated with delirium (O.R=6.2, 95% C.I=1.1-13.8) after adjusting for age, gender, education and economic status, lifestyle factors, multimorbidities and laterality. At follow-up, those with severe stroke had a stronger association between delirium and dementia (RRR=4.3, 95% C.I=1.2-15.6) or death (RRR=3.7, 95% C.I=1.1-12.1).


CONCLUSIONS
Delirium, in this sub-Saharan African sample, was already present in about one-third of survivors within one week of stroke. Survivors of severe stroke are at higher risk of delirium and its complications, and could be important target for delirium preventive interventions.
World Health Organization (WHO) Collaborating Centre for Research and Training in Mental Health, Substance Abuse and Neuroscience, Department of Psychiatry, College of Medicine, University of Ibadan, P.M.B 5017 (G.P.O), Ibadan, Nigeria. Electronic address: drakinjagbemi@yahoo.com.
Akin
A
Ojagbemi
Division of Neurology, Department of Medicine, College of Medicine, University of Ibadan, Nigeria.
Mayowa
M
Owolabi
World Health Organization (WHO) Collaborating Centre for Research and Training in Mental Health, Substance Abuse and Neuroscience, Department of Psychiatry, College of Medicine, University of Ibadan, P.M.B 5017 (G.P.O), Ibadan, Nigeria.
Toyin
T
Bello
World Health Organization (WHO) Collaborating Centre for Research and Training in Mental Health, Substance Abuse and Neuroscience, Department of Psychiatry, College of Medicine, University of Ibadan, P.M.B 5017 (G.P.O), Ibadan, Nigeria; Department of Psychiatry College of Medicine University of Ibadan, Nigeria.
Olusegun
O
Baiyewu
D000328:Adult; D000367:Age Factors; D000368:Aged; D003693:Delirium / Q000453:epidemiology* / Q000209:etiology*; D003704:Dementia / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D017063:Outcome Assessment, Health Care; D011203:Poverty; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications*
Acute confusional state; Prevention; Risk factors; Stroke burden; Vascular dementia