Abstract
Background
Very little is known about the outcomes of poststroke delirium in relation to its
symptom spectrum. We investigated the 3-months cognitive and functional outcomes of
attenuated (ADS) and full delirium syndromes in Nigerian survivors of first ever stroke.
Methods
A prospective observational study with repeated assessments conducted in the first
week of stroke using the confusion assessment method. Full delirium was diagnosed
according to criteria in the fifth edition of the diagnostic and statistical manual
of mental disorders (DSM-V). ADS was characterised in survivors who were free of full,
but had ≥two core features of, delirium. Baseline and follow-up assessments were conducted
using the Mini-Mental state examination (MMSE), 10-words list learning and delayed
recall test, Animal naming test and Barthel index.
Results
Among 150 participants, ADS was present in 32 (21.3%), full delirium in 29 (19.3%).
In linear regression analyses adjusting for age, economic status and systemic hypertension,
ADS [(Mean difference (MD) = -3.8, 95% C.I = -7.0, -0.7)] and full delirium (MD = -5.6,
95% C.I = -9.0, -2.1) independently predicted poorer global cognitive functioning
at follow-up. Significant declines in memory (MD = -1.9, 95% C.I = -2.8, 0.9), executive
(MD = -2.2, 95% C.I = -4.1, -0.3) and physical functioning (MD = -2.8, 95% C.I = -5.5,
-0.2), as well as a 4-fold increase in the independent odds (O.R) for dementia (O.R = 4.1,
95% C.I = 1.0,16.1) were also recorded in full, but not attenuated, delirium.
Conclusion
Attenuated and full delirium are associated with graded risk of poststroke cognitive
decline. Reconsideration of poststroke delirium as a spectrum, rather than threshold-based
categorical diagnosis will improve detection and prioritization of stroke survivors
at increased risk of cognitive decline.
Key Words
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Article info
Publication history
Published online: August 25, 2020
Accepted:
August 12,
2020
Received in revised form:
August 8,
2020
Received:
July 2,
2020
Footnotes
Attribution: Department of Psychiatry, College of Medicine University of Ibadan, Nigeria.
Grant support: Medical Education Partnership Initiative- Junior Faculty Research Training Program [under Fogarty International grant number D43TW010140].
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105251
Copyright
© 2020 Elsevier Inc. All rights reserved.
