Cognitive and functional outcomes in elderly patients with post-stroke delirium

Abstract

Delirium is common after stroke in elderly patients and may be associated with short and long-term changes in cognitive function. We aimed to assess disease trajectories and functional outcome in post stroke delirium. Methods: A prospective study of elderly patients admitted to geriatric rehabilitation after an acute stroke. Patients with delirium were identified with the use of the Confusion Assessment Method (CAM) criteria for delirium. Patients with delirium were assessed daily during hospitalization using the Delirium Rating Scale (DRS-R-98) and the MOTYB test. Functional outcome was assessed in all stroke patients by FIM scores at admission and on discharge and by FIM change and efficiency. Results: The majority of the 30 participants in whom delirium developed after a stroke continue to be delirious during the hospitalization. Twenty days after admission 19 patients (66.3%) were still delirious. Cognitive performance had a steady improvement until discharge. FIM scores on admission and discharge were significantly lower in stroke patients with delirium. Being a post-stroke delirium patient was independently associated with lower FIM at admission (38.4±9.7 vs. 50.7±18.1; P <0.01), lower FIM at discharge (45.8±14.0 vs. 72.5±23.8; P <0.001), lower FIM change (7.5±3.0 vs. 22.9±17.6; P <0.001), and lower FIM Efficiency (0.42±0.16 vs. 0.95±0.1; P <0.01). Conclusion: The majority of post-stroke delirium patients were still delirious during the first month of rehabilitation and there was an ongoing improvement in delirium severity until discharge. Post-stroke delirium adversely affects rehabilitation outcome of stroke patients and is associated with substantial loss of functional independence.