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Frequency and predictors of post-stroke delirium in PRospective Observational POLIsh Study (PROPOLIS)

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Abstract

Delirium is the most common and serious neurobehavioral complication in acute hospital admissions. Some patients develop signs of delirium but do not meet all diagnostic criteria. Stroke is a major risk factor for delirium. The aim of this prospective study was to build a predictive model for delirium and subsyndromal post-stroke delirium. Patients with stroke were screened for delirium during the first 7 days after admission. Delirium was diagnosed according to DSM-V criteria. Baseline demographic, biochemical, stroke-related data, medications used, neurological deficit, and premorbid cognitive and functional impairment were assessed. 750 consecutive stroke patients (71.75 ± 13.13 years) were recruited; 203 (27.07%) had delirium. In predictive model for delirium MoCA score and white blood count on admission, neglect, vision deficits, physical impairment, and higher comorbidity prior to stroke had the highest predictive value. Subsyndromal delirium was diagnosed in 60 patients. MoCA score and potassium level on admission, and urinary tract infection during hospitalization had the highest predictive value for its development. Delirium occurs in one-fourth of admissions due to stroke; subsyndromal delirium is less prevalent and affects less than one per ten patients. The hyperactive form is the most rare type of delirium. The factors best predicting delirium are easily assessed in everyday practice and their co-occurrence in patients with stroke should alert the treating physician of high risk of delirium.

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Acknowledgements

We thank Malgorzata Mazurek for editing assistance.

Funding

The Leading National Research Centre funded the collection of data for the study.

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Authors and Affiliations

  1. Department of Neurology, University Hospital, Botaniczna 3, 31-503, Krakow, Poland

    P. Pasinska, E. Klimiec, A. Szyper-Maciejowska & A. Klimkowicz-Mrowiec

  2. Department of Neurology, School of Medicine, Jagiellonian University, Botaniczna 3, 31-503, Krakow, Poland

    P. Pasinska, K. Kowalska, E. Klimiec & A. Klimkowicz-Mrowiec

  3. Department of Neurosurgery and Neurotraumatology, University Hospital, Botaniczna 3, 31-503, Krakow, Poland

    A. Wilk

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  1. P. Pasinska
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  2. K. Kowalska
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  3. E. Klimiec
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  4. A. Szyper-Maciejowska
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  6. A. Klimkowicz-Mrowiec
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Correspondence to A. Klimkowicz-Mrowiec.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Pasinska, P., Kowalska, K., Klimiec, E. et al. Frequency and predictors of post-stroke delirium in PRospective Observational POLIsh Study (PROPOLIS). J Neurol 265, 863–870 (2018). https://doi.org/10.1007/s00415-018-8782-2

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  • DOI: https://doi.org/10.1007/s00415-018-8782-2

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