Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.
J Stroke Cerebrovasc Dis. 2024 Jun;33(6):107667. doi: 10.1016/j.jstrokecerebrovasdis.2024.107667. Epub 2024 Feb 27.
Delirium, an acute and fluctuating mental disturbance of attention, cognition, and consciousness, commonly occurs in acute stroke. Research on long-term outcomes of stroke patients experiencing delirium is limited, especially regarding cognitive and psychiatric symptoms.
As part of the Nor-COAST study, 373 patients were screened for delirium using the Confusion Assessment Method (CAM) in the acute phase of stroke. Patients were included in the mixed-model linear regression analyses if they had available data from the follow-ups at three, 18 or 36 months, totaling 334 (44.6 % women, mean (SD) age: 72.1 (12.5) years, 17 (5.1 %) diagnosed with delirium). Global cognition was measured using the Montreal Cognitive Assessment (MoCA). Psychiatric symptoms were measured using the Hospital Anxiety and Depression Scale (HADS) and the Neuropsychiatric Inventory-Questionnaire (NPI-Q).
At three months, delirium was associated with a higher NPI-Q score (Mean (SD) 2.9 (3.6) vs 1.4 (2.2)). At 18 and 36 months, delirium was associated with a lower MoCA score (Mean (SD) 19.7 (6.6) vs 24.3 (5.0), and 20.6 (7.6) vs 24.6 (4.8)), higher HADS anxiety symptoms (5.0 (4.3) vs 3.3 (3.3), and 5.9 (4.1) vs 3.4 (3.6)), higher HADS depression symptoms (7.2 (4.7) vs 3.4 (3.3), and 6.6 (5.1) vs 3.7 (3.7)), and higher NPI-Q score (2.4 (4.4) vs 1.7 (2.3), 2.6 (4.5) vs 1.0 (1.9)). Delirium significantly predicted the psychiatric symptoms hallucinations and agitation.
Patients with delirium in the acute phase of stroke may be particularly vulnerable to developing cognitive and psychiatric symptoms in the chronic phase.
谵妄是一种注意力、认知和意识急性波动的精神障碍，在急性脑卒中中较为常见。目前关于经历谵妄的脑卒中患者长期预后的研究有限，特别是认知和精神症状方面。
作为 Nor-COAST 研究的一部分，373 名患者在脑卒中急性期使用意识混乱评估法（CAM）筛查谵妄。如果患者在 3 个月、18 个月或 36 个月的随访中存在可用数据，那么将其纳入混合模型线性回归分析中，共纳入 334 名患者（44.6%为女性，平均（标准差）年龄为 72.1（12.5）岁，17 名（5.1%）患者被诊断为谵妄）。采用蒙特利尔认知评估（MoCA）评估整体认知功能。采用医院焦虑抑郁量表（HADS）和神经精神问卷-问卷（NPI-Q）评估精神症状。
在 3 个月时，谵妄与较高的 NPI-Q 评分相关（均数（标准差）为 2.9（3.6）比 1.4（2.2））。在 18 个月和 36 个月时，谵妄与较低的 MoCA 评分相关（均数（标准差）为 19.7（6.6）比 24.3（5.0），20.6（7.6）比 24.6（4.8）），较高的 HADS 焦虑症状（5.0（4.3）比 3.3（3.3），5.9（4.1）比 3.4（3.6）），较高的 HADS 抑郁症状（7.2（4.7）比 3.4（3.3），6.6（5.1）比 3.7（3.7））和较高的 NPI-Q 评分（2.4（4.4）比 1.7（2.3），2.6（4.5）比 1.0（1.9））。谵妄显著预测了精神症状幻觉和激越。
在脑卒中急性期发生谵妄的患者在慢性期可能特别容易出现认知和精神症状。
