Stroke patients with delirium may be more prone to developing cognitive and psychiatric difficulties

Stroke patients with delirium may be more prone to developing cognitive and psychiatric difficulties

Stroke patients who experience delirium during a stroke may be more susceptible to developing cognitive and psychiatric difficulties.

Every year in Norway, around 9,000 people are hospitalized with a stroke. Some of those who have a stroke also experience a temporary state of acute confusion. This condition is called delirium and is often associated with illness and medical procedures.

Now we have found that patients who experience this temporary state of confusion during a stroke sometimes experience greater cognitive and emotional challenges in the aftermath.

In Norway, about ten percent of stroke patients experience delirium. Delirium is characterized by the patient suddenly appearing disoriented and inattentive, without this being due to previous dementia or known brain diseases. The patient may be easily distracted, have difficulty maintaining a conversational thread, and his or her thoughts and statements may be disjointed. The condition diminishes over time, but the number of hours or days that the patient is confused may vary.

Even if the state of confusion is temporary, it is important to assess whether it can lead to long-term problems for stroke patients.

Multiple tests used

That's exactly what researchers from the Vascular Diseases Research Group (VaD) at the Norwegian University of Science and Technology (NTNU) wanted to investigate.

Researchers were interested in whether patients who developed delirium during a stroke performed worse on cognitive and psychiatric measures in the years afterward. The group is led by Ramune Grambaite, associate professor of clinical neuropsychology and clinical manager for the neuropsychological outpatient clinic at the Department of Psychology at NTNU. Vilde Nerdal shares first authorship with Elise Gjestad, a doctoral student in psychology at the Institute of Psychology at NTNU. The work was carried out under the supervision of Associate Professor Grambaite.

The researchers developed a study with several dedicated researchers on the long-term effects of delirium in stroke patients. This is a field that is poorly understood both nationally and internationally.

Patients with delirium struggled more

The analyzes showed that stroke patients who experienced delirium during the stroke actually had a greater chance of developing cognitive and psychiatric difficulties in the following years.

The patients with delirium performed worse on cognitive tests at 3 months, 18 months and 36 months. They suffered from greater cognitive impairment compared to stroke patients who had not experienced delirium.

Additionally, delirium has been found to increase the likelihood of anxiety and other emotional symptoms in the years following stroke.

After three years, the stroke patients with delirium had greater anxiety than the patients who had not experienced this state of confusion during their stroke. Questionnaires assessing emotional difficulties also showed that patients with delirium performed better (worse) on these measures.

Several possible reasons

It is difficult to identify a specific reason why delirium increases the likelihood of cognitive and psychiatric symptoms.

It may be that patients experiencing delirium have greater vulnerabilities to begin with. However, the results were similar when we took into account factors such as dementia, complications and other illnesses during the stroke. We may not be able to explain the symptoms solely by previous dementia or other vulnerabilities. Another explanation could be that the state of confusion itself is frightening and interferes with the rehabilitation process.

Although it is not known what specific mechanisms cause the symptoms described, it is important to take the condition seriously. Perhaps the state of confusion should be understood as a kind of warning that the patient is exposed to great medical and psychological stress during the stroke, and the researchers' results show that this may have consequences in the future. The results suggest that these stroke patients may require specialized follow-up care in the post-acute phase of stroke.

More research on delirium needed

The researchers emphasize that more research is needed on the long-term effects of delirium during a stroke. Better knowledge could enable better follow-up of this patient group and reduce long-term consequences. The research may also shed light on how to prevent delirium in patients. Understanding delirium is important in combating dementia and psychiatric symptoms after a stroke.

All data comes from Nor-COAST's comprehensive study, which followed stroke patients from Trondheim, Ålesund, Bergen, Oslo and Bærum for three years. The study recorded whether the patients had delirium during the stroke and how they felt afterwards. The study comes from the Department of Neuromedicine and Movement Science at NTNU and was funded by Nasjonalforeningen for Folkehelsen's dementia research program.

Source:

The Norwegian University of Science and Technology (NTNU)

Reference:

Nerdal, V., et al. (2022) The relationship of acute delirium with cognitive and psychiatric symptoms after stroke: a longitudinal study. BMC Neurology. doi.org/10.1186/s12883-022-02756-5.

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