However, the diagnosis of delirium is often quite difficult and even more so in stroke patients, due to prevalent language disorders, neglect, mood disturbances and cognitive impairment. Hyperactive delirium often attracts the attention of medical personnel but is 3 times less common than the hypoactive delirium subtype, which can be easily missed when the patient is perceived as cooperative and exhibits few behavioral problems.4
There are many factors that can increase the risk of developing post-stroke delirium. It is more common in patients with advanced age, worse pre-stroke function and cognitive impairment, more severe stroke, previous depression, use of certain medications, comorbid disorders and co-occurring infection.1,4 In addition patients with visio-spatial neglect (which is more commonly associated with right hemispheric strokes) and any kind of visual disturbances (poor vision pre-stroke, hemianopsia) have an increased risk of delirium.4,5
Early detection of delirium is crucial to tailor specific interventions, however there is much uncertainty about which tools to use in stroke patients. The 4-Assessment Test for delirium (4AT) and the Confusion Assessment Method-Intensive Care Unit (CAM-ICU) have been studied most and both have a high sensitivity and specificity.6 Without structured assessment and often serial observations delirium can be missed, especially the hypoactive subtype.7 The majority of delirium is detected on the first day of admission and the remainder within the next 5 days,8 therefore ideally patients should be assessed for delirium regularly during at least this time period.
- Shaw RC, Walker G, Elliott E, Quinn TJ. Occurrence Rate of Delirium in Acute Stroke Settings Systematic Review and Meta-Analysis. Stroke. 2019;50:3028-3036
- Shi Q, Presutti R, Selchen D, Saposnik G. Delirium in Acute Stroke. A Systematic Review and Meta-Analysis. Stroke. 2012;43:645-649.
- Righy C, Rosa RG, da Silva RTA, et al.Prevalence of post-traumatic stress disorder symptoms in adult critical care survivors: a systematic review and meta-analysis. Crit Care2019;23:213
- Pasinska P, Kowalska K, Klimiec E, et al. Poststroke Delirium Clinical Motor Subtypes: The PRospective Observational POLIsh Study (PROPOLIS). J Neurol2018;265:863–870
- Pasinska P, Kowalska K, Klimiec E, et al.Poststroke Delirium Clinical Motor Subtypes: The PRospective Observational POLIsh Study (PROPOLIS). J Neuropsychiatry Clin Neurosci 2019:31:104-111
- Mansutti I, Saiani L, Palese A. Detecting delirium in patients with acute stroke: a systematic review of test accuracy. BMC Neurology 2019;19:310
- Klimiec E, Dziedzic T, Kowalska K, et al. Knowns and Unknowns About Delirium in Stroke: A Review. Cogn Behav Neurol. 2016;29:4
- Shaw R, Drozdowska B, Taylor-Rowan M, et al. Delirium in an Acute Stroke Setting, Occurrence, and Risk Factors. Stroke. 2019;50:00-00.
- Siddiqi N, Harrison JK, Clegg A, et al. Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database of Systematic Reviews 2016;3. Art. No.: CD005563.
- Song J, Lee M, Jung D. The Effects of Delirium Prevention Guidelines on Elderly Stroke Patients. Clinical Nursing Research 2018;27(8):967-983
- Brown EG, Josephson A, Anderson N, et al. Evaluation of a multicomponent pathway to address inpatient delirium on a neurosciences ward. BMC Health Serv Res 2018;18:106