Introduction
Ischemic
stroke is becoming increasingly prevalent with an aging population; yet
even most advanced reperfusion therapies are viable in only about 20%
of patients.1,2
There is hence a pivotal role for the management of secondary
complications to enhance long-term outcome in patients not amenable for
or with unsuccessful reperfusion attempts. Post-stroke delirium (PSD)
affects up to 39% of patients with ischemic stroke, is associated with
inferior functional and cognitive outcome, and poses a critical, yet
modifiable, predictor for poor recovery.3,4
Unfortunately, PSD management is generally unstandardized, affected
patients remain unrecognized, and initiation of pharmacological and
non-pharmacological interventions is delayed.3,5
While it remains to be clarified to what extent interventional
approaches can reduce the impact of manifest PSD, prevention of PSD is
effective and can avert up to one-third of cases.4,6
Prevention could be facilitated by knowledge of risk factors for PSD
since patients at risk could be easier identified and effects of
modifiable risk factors mitigated.
We performed a review of studies that investigated risk factors for PSD (Supplemental Table 1),
which generally identified age, stroke severity, infection,
deliriogenic medication, and pre-stroke cognitive or functional
impairment. Unfortunately, most studies are methodologically biased
(retrospective designs, inappropriate choice of screening tools or
frequency) and none evaluated risk factors for PSD duration, which
substantially impacts neurocognitive outcome following delirium.7
Consequently, recently updated German guidelines on acute stroke
management concluded that evidence for the clinical management of PSD is
insufficient.8
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