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Post-stroke delirium in relation to dementia and long-term mortality

Authors

  • Susanna Melkas,

    Corresponding author
    • Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
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  • Jouko V. Laurila,

    1. Departments of Internal Medicine and Geriatrics, Helsinki University Central Hospital, Helsinki, Finland
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  • Risto Vataja,

    1. Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
    2. Kellokoski Hospital, Kellokoski, Finland
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  • Niku Oksala,

    1. Division of Vascular Surgery, Department of Surgery, Tampere University Hospital, Tampere, Finland
    2. School of Medicine, Forensic Medicine, University of Tampere and the Laboratory Centre Research Unit, Tampere University Hospital, Tampere, Finland
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  • Hanna Jokinen,

    1. Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
    2. Department of Psychology, University of Helsinki, Helsinki, Finland
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  • Tarja Pohjasvaara,

    1. Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
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  • Antero Leppävuori,

    1. Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
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  • Markku Kaste,

    1. Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
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  • Pekka J. Karhunen,

    1. School of Medicine, Forensic Medicine, University of Tampere and the Laboratory Centre Research Unit, Tampere University Hospital, Tampere, Finland
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  • Timo Erkinjuntti

    1. Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
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S. Melkas, MD, Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland. E-mail: susanna.melkas@hus.fi

Abstract

Background

Delirium is a frequent post-stroke complication that compromises effective rehabilitation and has been associated with poor outcome. We aimed to investigate whether delirium is associated with increased risk of post-stroke dementia and long-term mortality once confounding is taken into account.

Methods

The study comprised 263 consecutive acute ischemic stroke patients aged 55–85 years admitted to the emergency department of a university hospital. The cohort included three-month survivors followed up for 10 years. The diagnosis of post-stroke delirium during the first 7 days after stroke was based on the DSM-IV criteria.

Findings

Of all the patients, 50 (19.0%) were diagnosed with delirium. Low education, pre-stroke cognitive decline, and severe stroke indicated by a Modified Rankin score between 3 and 5 were risk factors for post-stroke delirium, which was also associated with diagnosis of dementia at 3 months post-stroke. In the Kaplan–Meier analysis, delirium was associated with poor long-term survival (6.1 versus 9.1 years). In the stepwise Cox regression proportional hazards analysis adjusted for demographic factors and risk factors, advanced age (hazard ratio [HR] 1.08) and stroke severity (HR 1.83), but not post-stroke delirium, were associated with poor survival.

Interpretation

In our well-defined cohort of post-stroke patients, acute stage delirium was diagnosed in one in five patients and associated with dementia at 3 months. Advanced age and stroke severity were related to the higher long-term mortality among patients with post-stroke delirium. Copyright © 2011 John Wiley & Sons, Ltd.

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