From the Department of Neurology, School of Medicine, Jagiellonian University, Krakow, Poland (PP, KK, EK, AW, AS-M, TD, AK-M).
J Neuropsychiatry Clin Neurosci. 2019 Spring;31(2):104-111. doi: 10.1176/appi.neuropsych.18040073. Epub 2018 Nov 8.
Although delirium is the most common neurobehavioral complication after stroke, its motor subtypes-hypoactive, hyperactive, mixed, and none-as well as their risk factors are not well characterized. Motor subtypes influence recognition and prognosis of delirium in hospitalized patients.
The aim of this prospective study was to assess the frequency of poststroke delirium subtypes and to describe their predictive models. Consecutive patients with stroke were screened for delirium with the Confusion Assessment Method for the Intensive Care Unit. Delirium was diagnosed according to DSM-5 criteria, and subtypes were classified with the Delirium Motor Subtype Scale-4. Baseline demographic characteristics, biochemistry, stroke-related data, medications, neurological deficits, and premorbid cognitive and functional impairments were assessed.
Out of 750 patients (mean age, 71.75 years [SD=13.13]), 203 (27.07%) had delirium: 85 (11.34%) were hypoactive, 77 (10.27%) were mixed hypoactive-hyperactive, 31 (4.13%) were hyperactive, and 10 (1.33%) had an unspecified type. Cognitive impairment at the time of hospital admission and spatial neglect, among other factors, were identified as the best predictors for all motor delirium subtypes.
Screening for poststroke delirium is important because the hypoactive subtype bears the worst prognosis and is misdiagnosed the most compared with other subtypes. All identified factors for the predictive models of delirium subtypes are routinely assessed during hospital admission. Their occurrence in patients with stroke should alert the treating physician to the high risk for a particular delirium subtype.
尽管谵妄是中风后最常见的神经行为并发症，但它的运动亚型——低动力型、高动力型、混合性和无动力型，以及它们的危险因素尚未得到很好的描述。运动亚型会影响住院患者对谵妄的识别和预后。
本前瞻性研究旨在评估中风后谵妄亚型的频率，并描述其预测模型。连续的中风患者通过重症监护谵妄评估方法进行谵妄筛查。根据 DSM-5 标准诊断谵妄，并使用 Delirium Motor Subtype Scale-4 进行亚型分类。评估基线人口统计学特征、生物化学、中风相关数据、药物、神经功能缺损和发病前认知和功能障碍。
在 750 名患者中（平均年龄 71.75 岁[SD=13.13]），203 名（27.07%）患有谵妄：85 名（11.34%）为低动力型，77 名（10.27%）为混合性低动力-高动力型，31 名（4.13%）为高动力型，10 名（1.33%）为未指定型。入院时的认知障碍和空间忽视等因素被确定为所有运动性谵妄亚型的最佳预测因素。
对中风后谵妄进行筛查很重要，因为与其他亚型相比，低动力型的预后最差，且误诊率最高。所有识别出的谵妄亚型预测模型的因素在住院期间都被常规评估。中风患者出现这些因素应引起治疗医生的注意，警惕特定谵妄亚型的高风险。
