Qu Jianfeng, Chen Yangkun, Luo Genpei, Zhong Huohua, Xiao Weimin, Yin Hanpeng
Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, Guangdong Province, China.
Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, Guangdong Province, China.
J Stroke Cerebrovasc Dis. 2018 Oct;27(10):2641-2647. doi: 10.1016/j.jstrokecerebrovasdis.2018.05.034. Epub 2018 Jun 29.
The aim of this prospective cohort study was to assess the incidence and risk factors of delirium following acute ischemic stroke, as well as its effects on functional outcome.
Two hundred and sixty-one patients with acute ischemic stroke were screened for delirium during the first week after admission. Delirium was diagnosed according to the Confusion Assessment Method. If delirium was present, delirium rating scale-revised-98 was used to assess its severity. Neurologic deficits were assessed with the National Institutes of Health Stroke Scale (NIHSS). Brain magnetic resonance imaging assessment quantified the infarction, white matter lesions, and medial temporal lobe atrophy. Functional outcome assessment included the modified Rankin Scale and Lawton Instrumental Activities of Daily Living scale at 3 and 6 months after the index stroke.
Thirty-eight (14.6%) patients with acute ischemic stroke developed delirium during the first week of admission. Patients with poststroke delirium (PSD) were older, had higher NIHSS scores on admission, and were more likely to have a previous stroke, an infection, and a left cortical infarct. Furthermore, left cortical infarction, older age, severer neurological deficit and having a previous stroke increased the risk of PSD. PSD was associated with a worse functional outcome.
The incidence of delirium was 14.8% in the first week after admission with acute ischemic stroke. Age, having a previous stroke, stroke severity, and left-cortical infarction were independently predictors of PSD. PSD may result in a significantly worse functional outcome.
这项前瞻性队列研究旨在评估急性缺血性卒中后谵妄的发生率、危险因素及其对功能转归的影响。
对261例急性缺血性卒中患者在入院后第一周进行谵妄筛查。根据意识模糊评估法诊断谵妄。若存在谵妄，则使用谵妄评定量表修订版98评估其严重程度。用美国国立卫生研究院卒中量表（NIHSS）评估神经功能缺损。脑磁共振成像评估对梗死、白质病变和内侧颞叶萎缩进行量化。功能转归评估包括在首次卒中后3个月和6个月时的改良Rankin量表和Lawton日常生活能力量表。
38例（14.6%）急性缺血性卒中患者在入院第一周发生谵妄。卒中后谵妄（PSD）患者年龄较大，入院时NIHSS评分较高，且更可能有既往卒中史、感染和左侧皮质梗死。此外，左侧皮质梗死、高龄严重神经功能缺损和既往有卒中史增加了发生PSD的风险。PSD与较差的功能转归相关。
急性缺血性卒中患者入院后第一周谵妄的发生率为14.8%。年龄、既往有卒中史、卒中严重程度和左侧皮质梗死是PSD的独立预测因素。PSD可能导致功能转归明显更差。
