Abstract T P304: Disordered Attention May Persist After Resolution of Post-Stroke Delirium
Introduction: Delirium after acute stroke has been associated with worse outcomes but the effect on domain specific health-related quality of life (QOL) is less well-defined. We hypothesized that post-stroke delirium is associated with worse QOL.
Methods: A prospective cohort of acute ischemic stroke patients was screened for post-stroke delirium. Delirium was diagnosed using the Confusion Assessment Method. Patient variables were prospectively recorded including initial NIHSS score and medical complications. Six QOL domains were assessed at three months post-stroke using Neuro-QOL (a validated patient-reported outcome tool that calculates T scores with means of 50 and standard deviations of 10): upper and lower extremity function, social roles satisfaction, fatigue, executive function (planning, calculating, and learning), and general cognitive concerns ([GCC] perceived attention, memory, and decision difficulties). Functional outcomes at 3 months were also obtained using the modified Rankin Scale (mRS, a validated outcome measure from 0, no symptoms, to 6, death). Univariate associations between delirium and QOL domains were identified and linear regression models were developed for domains with significant associations.
Results: Over 10 months 246 patients (56% male, mean 65 years) met inclusion criteria. Delirium occurred in 30 (12%) patients. Three month follow up exceeded 90%. Of the Neuro-QOL domains, only GCC was significantly different between those with delirium and those without (T-scores 48.6 vs. 53.4, p=0.03). The mRS outcomes did not differ between those with delirium and those without (median [interquartile range], 1 [0-3] vs 1 [0-2]; p=0.59). Delirium (Beta -3.8, p=0.02) and initial NIHSS (Beta -0.25, p=0.006) were associated with worse GCC after correction for covariates.
Conclusion: Our finding that post-stroke delirium is independently associated with worse measures of cognition at three months suggests that the disordered attention of delirium may persist long term. Delirium may impair recovery after stroke or may represent a separate mechanism of neurologic injury not well characterized by global outcome scales like the mRS.
Author Disclosures: E.M. Liotta: None. C. Corado: None. D.L. Bergman: None. R.A. Bernstein: Research Grant; Modest; Boehringer Ingelheim, Medtronic, Pfizer-BMS, Athersys. Speakers' Bureau; Modest; Medtronic. Consultant/Advisory Board; Modest; Janssen. Speakers' Bureau; Significant; Boehringer Ingelheim, BMS-Pfizer. F.Z. Caprio: None. Y. Curran: None. J.C. Guth: None. M.B. Maas: None. A.M. Naidech: None. S. Prabhakaran: None.
- © 2014 by American Heart Association, Inc.