Delirium in acute ischemic stroke: risk factors, sequelae, and pathogenetic treatment

Introduction. Delirium, or an acute confusional state, is a common complication affecting between 10 and 48% of acute stroke patients. In the acute phase of stroke, delirium contributes to prolonged hospital stays, higher treatment costs and in-hospital and long-term mortality, increased risk of disability, and reduced potential for post-stroke rehabilitation.

The aim of this study is to identify delirium risk factors in acute stroke patients, to study the effects of delirium on mortality rates, post-stroke cognitive functioning, and to assess treatment options.

Materials and methods. One hundred and thirty-eight patients (93 males and 45 females) with a mean age of 71 [69.0; 74.8] years were enrolled in the study. Delirium was assessed using the Confusion Assessment Method (CAM); for initial assessment and repeated measurements of delirium severity, the Delirium Rating Scale (DRS) was used. Pre-stroke cognitive decline was assessed retrospectively using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Neuropsychological testing and assessment of caregiver burden using the Caregiver Burden Scale (CBS) were performed at 3, 6, and 18 months post-stroke onset.

Results. An IQCODE score of > 91 is a risk factor for severe delirium in acute stroke patients (p < 0.001). Severe delirium in acute stroke was associated with greater cognitive deficits (p < 0.05) and greater caregiver burden (р < 0.01) at 3 and 6 months post-stroke. DRS score > 15 and delirium duration > 10 days were found to be death risk factors at 18 months after stroke onset (OR = 3.58; 95% CI 1.4–9.19; p = 0.008 and OR = 2.56; 95% CI 1.03–6.38; p < 0.044, respectively). Central acetylcholinesterase inhibitors reduced the delirium duration (p = 0.015), improved cognitive function at 3, 6, and 18 months post-stroke (p < 0.01), and decreased caregiver burden at 3 and 6 months post-stroke (р < 0.05).

Conclusion. Delirium in the acute phase of stroke contributes to post-stroke cognitive decline in the patients and greater burden for their caregivers. Central acetylcholinesterase inhibitors can improve the post-stroke patient’s condition and decrease the strain for caregivers.