Risk Factors and Functional Outcomes of Delirium in Acute Stroke: A Prospective Observational Study
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Abstract
Background: Stroke often results in complex neurological deficits, and the incidence of delirium among stroke patients can significantly impact clinical outcomes.
Objective: To determine the risk factors associated with the development of delirium among patients presenting with acute stroke and to assess the outcomes (mortality and functional outcomes assessed using Barthel index) at 1 month.
Methods: This was a prospective observational study conducted in the Intensive care and Stroke Units, Department of Neurology in a tertiary teaching healthcare facility in India between January 2023 and June 2024.
Results: The incidence of delirium among acute stroke patients was 21.0%. Patients with delirium were significantly older (mean age 67.3 years) compared to those without (57.4 years, p<0.001). Gender, hypertension, diabetes, smoking, and previous stroke or transient ischemic attack were not significantly associated with delirium. However, delirium patients had a higher prevalence of cardiac disease (47.6%, p=0.064). Neurologically, delirium was significantly linked with lower Glasgow Coma Scale (GCS) scores (p<0.001) and higher National Institutes of Health Stroke Scale (NIHSS) scores (p<0.001). Stroke types also differed; ischemic stroke was more common in non-delirium patients (73.4%), while intracerebral haemorrhage and right hemisphere strokes were more common in those with delirium (p=0.006 and p=0.018, respectively). Cardio-embolic strokes were more frequent in delirium patients (50.0%), while large-artery atherosclerosis (LAA) and small-artery occlusion (SAO) were more common in non-delirium patients. Delirium was associated with poorer functional outcomes, reflected by lower Barthel Index scores at one month (p<0.001), and higher mortality (28.6% versus 6.3%, p=0.004).
Conclusion: Delirium was significantly correlated with worse neurological status, poorer functional recovery, and increased mortality among stroke patients.