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Post-Stroke Delirium Course in Prospective Observational Polish Study (PROPOLIS)

Author(s): Paulina Pasinska, Katarzyna Kowalska, Aleksander Wilk, Aleksandra Szyper-Maciejowska, Aleksandra Klimkowicz-Mrowiec

Delirium is a very common neurobehavioral complication after a stroke. Several studies have investigated this issue with conflicting results; therefore the course, severity and fluctuations of cognitive and motor features still need to be elucidated on a large group of patients with delirium post-stroke. As such, the aim of this prospective study was to assess the natural history of post-stroke delirium in a large cohort of patients with stroke. Consecutive stroke patients were screened for delirium using the Confusion Assessment Method. The delirium was then diagnosed according to DSM-5 criteria. Subtypes of delirium were classified with Delirium Motor Subtype Scale-4, and the Delirium Motor Checklist was applied to assess the number of hyper- and hypoactive symptoms. Finally, the severity of delirium symptoms was assessed by Delirium Rating Scale-Revised-98 and Cognitive Test for Delirium. Out of 203 patients, 144 were diagnosed with delirium on the first day of their hospital stay. Delirium resolved in 42 patients within 3 days of hospitalization, with median delirium duration of 3 days. The seventy seven patients were still delirious on the seventh day of their hospitalization. With time, the tendency towards an increase in hypoactive features was observed in both mixed and hypoactive delirium subtypes. The severity of delirium symptoms was stable during individual episodes. Delirium usually develops at the beginning of hospitalization. The number of delirium cases declines gradually but many patients are still delirious at the time of discharge. The severity of delirium symptoms is generally stable, but there is a tendency for an increase in the number of hypoactive signs and a decrease in the number of hyperactive signs during an episode.

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