Prevalence and Risk Factors for Early Delirium in First-ever Ischemic Stroke: An Observational Study

Abstract

Introduction: Post-stroke delirium worsens the cognitive and physical disabilities after ischemic stroke. Early detection and treatment can improve outcomes.To determine the prevalence and risk factors for early post-stroke delirium in patients with acute ischemic stroke.

Materials and Methods: Demographic and clinical data were collected from adult patients with first-ever ischemic stroke presenting within 24 hours of symptom onset. The Confusion Assessment Method for Intensive Care Unit (CAM-ICU) was used to screen for delirium. Early delirium was defined as delirium occurring within 48 hours of admission. Univariate and multivariate analyses were done to identify risk factors associated with early delirium.

Results: The study included 146 patients, of whom 44(30%) developed early post-stroke delirium. On univariate analysis, risk factors identified were older age, severe stroke, aphasia, hemi-neglect, hemianopia, dysphagia, cortical location of infarcts, stroke due to large artery atherosclerosis, total anterior circulation stroke, large vessel occlusion, cerebral edema, early aspiration, post-stroke seizures, and early neurological deterioration. Older age (OR 1.14 per year [CI 1.08-1.21], p=<.001), presence of large vessel occlusion (OR 5.19[CI 1.41-19.39], p=0.01), and aphasia (OR 1.89 [CI .95-3.76], p= 0.04) emerged as independent risk factors in multivariate logistic regression analysis.

Conclusion: Early delirium occurred in one-third of patients with acute ischemic stroke. Intrinsic stroke-related factors, rather than infections or metabolic causes, are major predisposing factors. Aspiration pneumonia secondary to dysphagia is a modifiable risk factor. Screening for delirium should begin early after hospitalisation for acute ischemic stroke.