For a long time, delirium was considered a merely temporary dysfunction of the brain. Today, it is established that it is a brain disease associated with network dysfunction, neuroinflammation and impaired transmitter homeostasis in a multicausal model. Following an episode of delirium, many patients do not return to their prior level of cognitive and functional performance. In particular, failed or delayed diagnosis with consecutive inadequate therapy contribute to the development of long-term cognitive decline that may ultimately lead to long-term care. Stroke patients are a particularly common delirium-affected population (10-46% depending on severity). Despite the frequency and clinical relevance of delirium in stroke patients, diagnostic characteristics of common screening methods are unknown. Similarly, the clinical phenotype and risk factors of patients who develop delirium have not been adequately described. This study primarily aims to evaluate the diagnostic properties of established screening tools for delirium in a prospective cohort of well-characterised patients following ischemic cerebral events (either transient or manifest stroke). Secondary outcome criteria include predictors of post-stroke delirium (PSD) such as stroke location and size, pre-stroke cognitive functioning, ability to participate in daily routine activities and medical conditions.
Study Type
OBSERVATIONAL
Enrollment
141
Patients are evaluated for the presence of PSD using DSM-5 criteria ("gold standard"). Established delirium detection tools are evaluated for their diagnostic accuracy compared to the gold standard.
Department of Neurology
Greifswald, Mecklenburg-Vorpommern, Germany
diagnostic accuracy of established delirium detection tools as compared to Diagnostic and Statistical Manual - 5th Version (DSM-5) criteria
Binary outcomes of delirium screening tests will be compared, i.e. if they characterize an individual patient as delirious at any of two time points during the 7 day observation period. Instruments include: Nursing Delirium Screening Scale (Nu-DESC), Confusion Assessment Method (CAM), rapid assessment test for delirium (4-AT). Binary outcomes ("yes" or "no" according to each of the scales) are then aggregated in one test that compares the observed frequency of delirious patients (according the above mentioned tests) with the actual number of delirious patients as assessed by the DSM-5 standard.
Time frame: two times daily for 7 days
PSD prevalence
DSM-5 criteria and chart review are used to assess the occurence of PSD among included patients over the complete study period
Time frame: three times daily for 7 days
pre-stroke modified Rankin Scale
functional status before stroke
Time frame: once on admission
pre-stroke Barthel Index
ability to take care of personal daily routine before stroke
Time frame: once on admission
pre-stroke Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)
cognitive impairment before stroke
Time frame: once on admission
pre-stroke Groningen Frailty Index (GFI)
presence of a frailty syndrome before stroke
Time frame: once on admission
National Institutes of Health Stroke Scale (NIHSS)
estimate of clinical stroke severity
Time frame: three times daily for three days starting on the day of admission
Critical Care Pain Observation Tool (CPOT)
pain during stroke unit treatment
Time frame: once daily for three days starting on the day of admission
Stroke location - clinical (classification of the OxfordshireCommunity Stroke Project (OCSP))
clinical characterisation based on phenotype as either total anterior, partial anterior, partial posterior or lacunar stroke
Time frame: once on admission
Stroke location - imaging (based on an atlas of anatomical regions of the human brain (aal MNI V4))
in patients with imaging of the definite stroke location, differences of mean locations between groups will be calculated
Time frame: once on admission
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