Delirium in the first days of acute stroke

Background and Purpose Delirium is an acute, transient disorder of cognition and consciousness with fluctuating intensity. The aim of this study was to investigate the presence and the risk factors for delirium in the first days after stroke onset. Patients and methods We assessed delirium prospectively in a sample of 218 consecutive patients (mean age 57 years) with an acute (:! 4 days) stroke (28 subarachnoid haemorrhages, 48 intracerebral haemorrhages, 142 cerebral infarcts) and in a control group of 50 patients with acute coronary syndromes with the Delirium Rating Scale (DRS) (cut-off score greater than or equal to 10). Results 29 (13%) acute stroke patients (mean DRS score = 13.2, SD = 2.3) and only one (2%) acute coronary patient had delirium (chi(2) = 5.2, p = 0.02). In nine patients delirium was secondary to stroke without any additional cause, in 10 patients there were also medical complications and in the remaining 10 there were multiple potential causes for delirium. Delirium was more frequent after hemispherical than after brainstem/cerebellum strokes (p = 0.02). No other statistically significant associations with stroke locations were found. Medical complications (OR = 4.3; 95 % CI = 1.8 to 10.2), neglect (OR = 3.5; 95% CI = 1.3 to 9.2), intracerebral haemorrhage (OR 3.1; 95% CI = 1.3 to 7.5) and age 65 (OR = 2.4; 95% Cl = 1.0 to 5.8) were independent factors to the development of delirium in stroke patients. Conclusion Delirium was more frequent in stroke than in coronary acute patients. Among stroke patients, delirium was most frequent in older patients, in those with neglect, with medical complications and with intracerebral haemorrhages. These findings indicated that delirium in acute stroke patients 1) is not a non-specific consequence of acute disease and hospitalisation and 2) is secondary to hemisphere brain damage and to metabolic disturbances due to medical complications.