Bilek Aaron Jason, Richardson Denyse
Geriatric Rehabilitation Department, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel.
Professor, Clinician Educator, and Department Head, Department of Physical Medicine and Rehabilitation, Queen's University and Providence Care Hospital, Kingston, Canada.
J Stroke Cerebrovasc Dis. 2023 Aug;32(8):107149. doi: 10.1016/j.jstrokecerebrovasdis.2023.107149. Epub 2023 May 26.
Post-stroke delirium (PSD) is a common yet underrecognized complication following stroke, with its effect on stroke rehabilitation being the subject of limited attention. The objective of this narrative review is to provide an overview of core issues in PSD including epidemiology, diagnostic challenges, and management considerations, with an emphasis on the rehabilitation phase.
Ovid Medline and Google Scholar were searched through February 2023 using keywords related to delirium, rehabilitation, and the post-stroke period. Only studies conducted on adults (≥18 years) and written in the English language were included.
PSD affects approximately 25% of stroke patients, and often persists well into the post-acute phase, with a negative impact on rehabilitation outcomes including lengths of stay, function, and cognition. Certain stroke and patient characteristics can help predict risk for PSD. The diagnosis of delirium becomes more challenging when superimposed on stroke deficits (such as attentional impairment or other cognitive, psychiatric, or behavioural disorders), leading to underdiagnosis, overdiagnosis, or misdiagnosis. Particularly in patients with post-stroke language or cognitive disorders, common screening tools are less accurate. The multidisciplinary rehabilitation team should be involved in management of PSD as rehabilitative activities can be beneficial for patients who can participate safely. Addressing barriers to effective delirium care at various levels of the health care system can improve rehabilitation trajectories for these patients.
PSD is a disease entity commonly encountered in the rehabilitation setting, but it is challenging to diagnose and manage. New delirium screening tools and management approaches specific for the post-stroke and rehabilitation settings are needed.
卒中后谵妄（PSD）是卒中后一种常见但未得到充分认识的并发症，其对卒中康复的影响受到的关注有限。本叙述性综述的目的是概述PSD的核心问题，包括流行病学、诊断挑战和管理考量，重点是康复阶段。
通过Ovid Medline和谷歌学术搜索截至2023年2月与谵妄、康复和卒中后时期相关的关键词。仅纳入针对成年人（≥18岁）且以英文撰写的研究。
PSD影响约25%的卒中患者，且常常持续到急性后期，对康复结局产生负面影响，包括住院时间、功能和认知。某些卒中和患者特征有助于预测PSD风险。当谵妄叠加在卒中缺陷（如注意力障碍或其他认知、精神或行为障碍）上时，诊断变得更具挑战性，导致诊断不足、过度诊断或误诊。特别是在有卒中后语言或认知障碍的患者中，常用的筛查工具准确性较低。多学科康复团队应参与PSD的管理，因为康复活动对能够安全参与的患者有益。解决医疗保健系统各级有效谵妄护理的障碍可改善这些患者的康复进程。
PSD是康复环境中常见的疾病实体，但诊断和管理具有挑战性。需要新的谵妄筛查工具和针对卒中后及康复环境的管理方法。
