• Susanna Melkas, Jouko V Laurila, Risto Vataja, Niku Oksala, Hanna Jokinen, Tarja Pohjasvaara, Antero Leppävuori, Markku Kaste, Pekka J Karhunen, and Timo Erkinjuntti.
• Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland. susanna.melkas@hus.fi
• Int J Geriatr Psychiatry. 2012 Apr 1;27(4):401-8.

BackgroundDelirium is a frequent post-stroke complication that compromises effective rehabilitation and has been associated with poor outcome. We aimed to investigate whether delirium is associated with increased risk of post-stroke dementia and long-term mortality once confounding is taken into account.MethodsThe study comprised 263 consecutive acute ischemic stroke patients aged 55-85 years admitted to the emergency department of a university hospital. The cohort included three-month survivors followed up for 10 years. The diagnosis of post-stroke delirium during the first 7 days after stroke was based on the DSM-IV criteria.FindingsOf all the patients, 50 (19.0%) were diagnosed with delirium. Low education, pre-stroke cognitive decline, and severe stroke indicated by a Modified Rankin score between 3 and 5 were risk factors for post-stroke delirium, which was also associated with diagnosis of dementia at 3 months post-stroke. In the Kaplan-Meier analysis, delirium was associated with poor long-term survival (6.1 versus 9.1 years). In the stepwise Cox regression proportional hazards analysis adjusted for demographic factors and risk factors, advanced age (hazard ratio [HR] 1.08) and stroke severity (HR 1.83), but not post-stroke delirium, were associated with poor survival.InterpretationIn our well-defined cohort of post-stroke patients, acute stage delirium was diagnosed in one in five patients and associated with dementia at 3 months. Advanced age and stroke severity were related to the higher long-term mortality among patients with post-stroke delirium.Copyright © 2011 John Wiley & Sons, Ltd.

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