Study finds delirium after stroke linked to poorer outcomes for patients
Up to 30 per cent of patients hospitalized after a stroke develop delirium, according to a new study from St. Michael’s Hospital.
Researchers found patients who experience delirium after stroke are five times more likely to die, and are more likely to be discharged to a long-term care facility, nursing home or have a longer stay in hospital.
“Early recognition and prevention of delirium are important for a quick recovery, better quality of life and timely discharge for patients who have suffered a stroke,” said Dr. Gustavo Saposnik, lead author of the paper and director of the Stroke Outcomes Research Centre at the hospital.
Saposnik and colleagues analyzed 10 studies that looked at the four common outcomes in over 2000 patients with delirium – inpatient and 12-month death rates, length of hospital stay and care arrangements after discharge.
Unlike dementia – a chronic, progressive mental disorientation – delirium is an acute, sudden state of confusion is often marked by lack of attention, disorientation, and sometimes hallucination.
Delirium is not only one of the most common complications that older patients develop after admission to hospital but it is also one of the most serious. Although stroke is a known predisposing factor for delirium, few studies have investigated this association and results from existing studies give conflicting results with prevalence estimates ranging from 13 to 48%. The aetiology of delirium post-stroke is poorly understood. There is no consensus on the best screening tool to use to detect delirium in the post-stroke setting. Specific stroke types may be more likely to precipitate delirium than others, for example, delirium is more frequent after intracerebral haemorrhage and total anterior circulation infarction (TACI). In addition, case reports have suggested that delirium may be associated with specific lesions, for example, in the thalamus and caudate nucleus. There is a lack of intervention data in both the prevention and treatment of delirium post-stroke. However, it is known that the development of delirium post-stroke has grave prognostic implications. It is associated with longer stay in hospital, increased mortality and increased risk of institutionalisation post discharge. In this article, we review the literature to date on delirium in the acute stroke setting.
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Age Ageing (2007) 36 (6): 613-618. doi: 10.1093/ageing/afm140
Patients can become delirious at any time after a stroke, however when it occurs seven to 10 days later it is commonly related to a complication such as a respiratory or urinary infection, instead of as part of the stroke’s effects.
Recognizing the associated risk factors such as age, severity of stroke, infections, narcotic use, lack of oxygen and cognitive impairment can help clinicians identify initial signs of delirium and use early interventions.
The paper is published in Stroke: Journal of the American Heart Association.
Saposnik said this research aims to encourage early detection and intervention to improve outcomes for patients and families, but further research is needed to understand the most effective interventions.
St. Michael’s Hospital has developed the Delirium Prevention Program (DPP) to reduce the occurrence of delirium – especially in elderly patients – and to improve patients’ experience.
Accourding to one study delirium occurs in almost 1 out of every 8 patients with stroke on a stroke unit and is associated with cognitive decline, infection, right-sided hemispheric stroke, anterior circulation large-vessel stroke, stroke severity, and brain atrophy. Delirium after stroke is associated with a worse outcome.
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Delirium in the acute phase after stroke
Incidence, risk factors, and outcome
A.W. Oldenbeuving, MD,
P.L.M. de Kort, MD, PhD,
B.P.W. Jansen, MD,
A. Algra, MD, PhD,
L.J. Kappelle, MD, PhD and
G. Roks, MD, PhD
The DPP is a multi-disciplinary team approach that uses simple strategies in everyday care to help keep patients oriented. Clocks have been installed in every patient’s room along with whiteboards, on which the date is written daily; Lights on the orthopedic unit and overhead paging systems are turned off at night to minimize confusion over time of day; and blinds are opened daily so patients have natural light rhythms.
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About St. Michael’s Hospital
St. Michael’s Hospital provides compassionate care to all who enter its doors. The Hospital also provides outstanding medical education to future health care professionals in more than 23 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, and care of the homeless are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing Knowledge Institute, research at St. Michael’s Hospital is recognized and put into practice around the world. Founded in 1892, the Hospital is fully affiliated with the University of Toronto.
For more information or to speak to Dr. Saposnik please contact:
Kate Taylor
Public Relations Specialist
St. Michael’s Hospital
Phone: 416-864-6060 x6537
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