Delirium within Three Days of Stroke in a Cohort of Elderly Patients

OBJECTIVES: To evaluate the incidence of stroke, riskfactors for stroke, and outcomes in elderly stroke patientswith delirium.DESIGN: Cohort study with 12-month follow-up.SETTING: Bankstown-Lidcombe Hospital, a 450-bedteaching hospital of the University of New South Wales,Sydney, Australia.PARTICIPANTS: One hundred fifty-six stroke patientsaged 65 and older recruited over 1 year.MEASUREMENTS: Incidence of delirium (defined in ac-cordance with Diagnostic and Statistical Manual of MentalDisorders, Fourth Edition, criteria) within 3 days post-stroke, length of hospital stay, discharge destination, short-andlong-termmortality,FunctionalIndependenceMeasure(FIM)scores,andMini-MentalStateExamination(MMSE)scores.RESULTS: Thirty-nine (25%) elderly stroke patients haddelirium within 3 days after stroke. Logistic regressionanalysis found that older age (P5.04), hemorrhagic stroke(P5.02), metabolic disorders (P5.003), dementia pre-stroke(P5.02),GlasgowComaScale(GCS)scorelessthan15 on admission (Po.001), and inability to lift both armson admission (P5.03) were independent predisposing fac-tors for delirium. Patients who had a cardioembolic stroke(odds ratio (OR)55.58) or total anterior circulation in-farction (OR53.42) were also more likely to develop de-lirium. Patients with delirium were associated with higher6- and 12-month mortality (Po.05), lower 12-month FIMand MMSE scores, and a higher 12-month institutionali-zation rate.CONCLUSION: Delirium occurred frequently in acutestroke patients aged 65 and older. Factors independentlyassociated with delirium included old age, intracerebralhemorrhage, metabolic factors, prestroke dementia, initialGCS less than 15, and inability to lift both arms onadmission. Patients with delirium had higher long-termmortality and a worse functional outcome. J Am GeriatrSoc 54:1192–1198, 2006.Key words: stroke; delirium; incidence; risk factor; mor-tality