Prediction models for post-stroke delirium: a systematic review with an exploratory meta-analysis of predictors

 

Why are your predicting failure to recover RATHER THAN DELIVERING RECOVERY?

Laziness? Incompetence? Or just don't care? NO leadership? NO strategy? Not my job? Not my Problem!

You're all fired! You need to create EXACT RECOVERY PROTOCOLS! 

You've known of the need for years and delivered nothing!  Take a hike!

39% post stroke delirium (4 posts to July 2021)

Prediction crapola like this does nothing to get survivors recovered! Your comeuppance when you have a stroke and don't recover will be a bitter pill for you to swallow.

Prediction models for post-stroke delirium: a systematic review with an exploratory meta-analysis of predictors

• W

  Weiya Ma

• 

  Sumin Ma † *

• Q

  Qiaomin Tang † *

• Y

  Yuanyuan Sun

• C

  Chen Hu

• Department of Nursing, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China

Abstract

Objective: 

To systematically identify and synthesize predictors of post-stroke delirium (PSD) derived from existing prediction models, and to assess the methodological quality of these studies using PROBAST.

Methods: 

A comprehensive systematic search was conducted in nine databases from inception to April 2026. Studies developing or validating prediction models for PSD were included. Data extraction was guided by the CHARMS checklist. Methodological quality and risk of bias were assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Meta-analysis was performed to pool the effect sizes of predictors and the area under the receiver operating characteristic curve (AUC).

Results: 

Sixteen studies (24 models) with sample sizes ranging from 100 to 14,475 were included. Model discrimination was moderate to good, with reported AUC values ranged from 0.72 to 0.94. The meta-analytic pooled AUC was 0.83 (95% Confidence interval: 0.81–0.85). Age, NIHSS (National Institutes of Health Stroke Scale score), neutrophil-to-lymphocyte ratio, visual impairment, and infection were identified as common significant predictors. PROBAST assessment revealed a high overall risk of bias in all studies, primarily due to methodological shortcomings in the analysis domain. Calibration was assessed in six studies with acceptable performance, whereas clinical utility was rarely evaluated.

Conclusion: 

This study highlights several important predictors of PSD. However, due to the high risk of bias, the reliability of existing models remains uncertain. Although the pooled AUC of 0.84 suggests moderate to good discrimination, its performance in individual clinical settings may vary markedly. Future studies should adhere to unified PSD diagnosis criteria, employ robust validation strategies, and explore advanced modeling techniques to improve model reliability and clinical utility.

More at link.

Delirium is a Potential Predictor of Unfavorable Long-term Functional Outcomes in Patients with Acute Ischemic Stroke: A Prospective Observational Study

 And you COMPLETELY FUCKING FAILED AT YOUR JOB OF CREATING PROTOCOLS TO PREVENT DELIRIUM! You're fired along with your mentors and senior researchers! I expect competence in stroke not this shitshow of useless research!

Delirium – an overlooked complication of stroke October 2020  

4.5 years to solve and you DID NOTHING!

Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? Your patients need an explanation of why you can't create delirium prevention protocols.

Delirium is a Potential Predictor of Unfavorable Long-term Functional Outcomes in Patients with Acute Ischemic Stroke: A Prospective Observational Study

Authors Lin C, Zhang H, Xiao F, Tu Y, Lin Y, Zhan L, Lin Y, Li Y , Xie C, Chen Y

Received 6 November 2024

Accepted for publication 4 March 2025

Published 18 March 2025 Volume 2025:18 Pages 4019—4035

DOI https://doi.org/10.2147/JIR.S505038

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Dr Xiaoyu Liu

Download Article [PDF] 

Chenhui Lin,^1,* Heyu Zhang,^1,* Fangyi Xiao,² Yujie Tu,³ Yaoyao Lin,¹ Luqian Zhan,⁴ Yisi Lin,⁵ Yanwei Li,¹ Chenglong Xie,¹ Yanyan Chen<sup>1

1</sup>Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China; ²Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China; ³Department of Neurology, Affiliated Hospital of Shaoxing University, Shaoxing, People’s Republic of China; ⁴Department of Neurology, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, 325000, People’s Republic of China; ⁵Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Yanyan Chen, Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People’s Republic of China, Email yychenyanyan@163.com

Purpose: Delirium is an acute fluctuating impairment of attention and awareness, common in acute ischemic stroke (AIS). This study aimed to evaluate the prognostic significance of delirium for neurological function at 3 months post-stroke, and develop a predictive model integrating delirium and biomarkers to enhance prognostic accuracy.
Methods: We conducted a prospective cohort study of patients admitted to the stroke unit (n=722). All patients were screened for daily delirium during clinical care. Plasma biomarkers were measured within 24 hours after admission. The main outcomes were evaluated with the 3-months modified Rankin Scale (mRS).
Results: Delirium developed in 10.2% of patients during the acute phase of stroke. Patients with post-stroke delirium (PSD) was significantly older (median age 74 vs 68 years, P< 0.001), more likely to have pre-stroke cognitive impairment (14.9% vs 4.8%, P=0.001), a higher prevalence of cardiovascular history (35.1% vs 16.2%, P< 0.001). PSD was also associated with higher scores of NIHSS (14.3 vs 9.1, P< 0.001) and greater scores of mRS (3.0 vs 1.5, P< 0.001) at admission. PSD patients showed worse outcomes, with elevated NIHSS and mRS scores at discharge and 3-month follow-up, as well as higher mortality rates (5.4% vs 1.4%, P=0.025). Biomarker analysis revealed increased plasma levels of inflammatory (white blood cells, neutrophils, C-reactive protein) and coagulation biomarkers (fibrinogen, D-dimer) in PSD patients, particularly those with poorer outcomes (P< 0.01). Our model, which incorporated delirium and biomarkers of inflammation and coagulation dysfunction, demonstrated strong predictive accuracy for adverse outcomes at 3 months with an AUC of 0.779 (95% CI=0.736– 0.822), with clinical utility confirmed by decision curve analysis.
Conclusion: PSD is a strong independent predictor of poor 3-month outcomes in AIS, including higher mortality and disability. Our findings highlight the critical role of inflammation and coagulation dysfunction in the pathogenesis of PSD. Furthermore, we present the clinical utility of a predictive model integrating delirium and relevant biomarkers to assess the risk of adverse outcomes at 3 months, suggesting potential targets for intervention.

Predictors of post-stroke delirium incidence and duration: Results of a prospective observational study using high-frequency delirium screening

 And you somehow think predicting delirium rather than preventing delirium does stroke survivors any fucking bit of good? Do you even have two functioning neurons to rub together? I'd have you all fired. 

Solve the fucking delirium problem, you've known about it for years.

1 in 4 have delirium post stroke from this research:

Delirium – an overlooked complication of stroke October 2020 

The latest useless shit here:

Predictors of post-stroke delirium incidence and duration: Results of a prospective observational study using high-frequency delirium screening

Show all authors

Robert Fleischmann*, Tina Andrasch*, Sina Warwas, ...

First Published July 21, 2022 Research Article Find in PubMed

https://doi.org/10.1177/17474930221109353

Article information

Abstract

Background:

Post-stroke delirium (PSD) is a modifiable predictor for worse outcome in stroke. Knowledge of its risk factors would facilitate clinical management of affected patients, but recently updated national guidelines consider available evidence insufficient.

Aims:

The study aimed to establish risk factors for PSD incidence and duration using high-frequency screening.

Methods:

We prospectively investigated patients with ischemic stroke admitted within 24 h. Patients were screened twice daily for the presence of PSD throughout the treatment period. Sociodemographic, treatment-related, and neuroimaging characteristics were evaluated as predictors of either PSD incidence (odds ratios (OR)) or duration (PSD days/unit of the predictor, b), using logistic and linear regression models, respectively.

Results:

PSD occurred in 55/141 patients (age = 73.8 ± 10.4 years, 61 female, National Institutes of Health Stroke Scale (NIHSS) = 6.4 ± 6.5). Age (odds ratio (OR) = 1.06 (95% confidence interval (CI): 1.02–1.10), b = 0.08 (95% CI = 0.04–0.13)), and male gender (b = 0.99 (95% CI = 0.05–1.93)) were significant non-modifiable risk factors. In a multivariable model adjusted for age and gender, presence of pain (OR < sub > mvar </sub >= 1.75 (95% CI = 1.12–2.74)), urinary catheter (OR < sub > mvar </sub > = 3.16 (95% CI = 1.10–9.14)) and post-stroke infection (PSI; OR < sub > mvar </sub > = 4.43 (95% CI = 1.09–18.01)) were predictors of PSD incidence. PSD duration was impacted by presence of pain (b < sub > mvar </sub >= 0.49 (95% CI = 0.19–0.81)), urinary catheter (b < sub > mvar </sub > = 1.03 (95% CI = 0.01–2.07)), intravenous line (b < sub > mvar </sub >= 0.36 (95% CI = 0.16–0.57)), and PSI (b < sub > mvar </sub >= 1.60 (95% CI = 0.42–2.78)). PSD (OR = 3.53 (95% CI = 1.48–5.57)) and PSI (OR = 5.29 (95% CI = 2.92–7.66)) independently predicted inferior NIHSS at discharge. Insular and basal ganglia lesions increased the PSD risk about four- to eight-fold.

Discussion/Conclusion:

This study identified modifiable risk factors, the management of which might reduce the negative impact PSD has on outcome.(My conclusion is you have no fucking clue on how to solve stroke!)

Keywords

Stroke, delirium, risk factors, duration, incidence

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

Predictors of post-stroke delirium incidence and duration: Results of a prospective observational study using high-frequency delirium screening

 Why in hell are you doing the useless research on predicting delirium rather than actually preventing delirium? Do you have two neurons to rub together?

Since we've known for years that 1 in 4 have delirium post stroke why are your mentors and senior researchers so incompetent they let you do prediction research rather than solution research?

• 1 in 4 have delirium post stroke (2 posts to July 2020)

Predictors of post-stroke delirium incidence and duration: Results of a prospective observational study using high-frequency delirium screening

Show all authors

Robert Fleischmann*, Tina Andrasch*, Sina Warwas, ...

First Published July 21, 2022 Research Article Find in PubMed 

https://doi.org/10.1177/17474930221109353

Article information

Abstract

Background:

Post-stroke delirium (PSD) is a modifiable predictor for worse outcome in stroke. Knowledge of its risk factors would facilitate clinical management of affected patients, but recently updated national guidelines consider available evidence insufficient.

Aims:

The study aimed to establish risk factors for PSD incidence and duration using high-frequency screening.

Methods:

We prospectively investigated patients with ischemic stroke admitted within 24 h. Patients were screened twice daily for the presence of PSD throughout the treatment period. Sociodemographic, treatment-related, and neuroimaging characteristics were evaluated as predictors of either PSD incidence (odds ratios (OR)) or duration (PSD days/unit of the predictor, b), using logistic and linear regression models, respectively.

Results:

PSD occurred in 55/141 patients (age = 73.8 ± 10.4 years, 61 female, National Institutes of Health Stroke Scale (NIHSS) = 6.4 ± 6.5). Age (odds ratio (OR) = 1.06 (95% confidence interval (CI): 1.02–1.10), b = 0.08 (95% CI = 0.04–0.13)), and male gender (b = 0.99 (95% CI = 0.05–1.93)) were significant non-modifiable risk factors. In a multivariable model adjusted for age and gender, presence of pain (OR < sub > mvar </sub >= 1.75 (95% CI = 1.12–2.74)), urinary catheter (OR < sub > mvar </sub > = 3.16 (95% CI = 1.10–9.14)) and post-stroke infection (PSI; OR < sub > mvar </sub > = 4.43 (95% CI = 1.09–18.01)) were predictors of PSD incidence. PSD duration was impacted by presence of pain (b < sub > mvar </sub >= 0.49 (95% CI = 0.19–0.81)), urinary catheter (b < sub > mvar </sub > = 1.03 (95% CI = 0.01–2.07)), intravenous line (b < sub > mvar </sub >= 0.36 (95% CI = 0.16–0.57)), and PSI (b < sub > mvar </sub >= 1.60 (95% CI = 0.42–2.78)). PSD (OR = 3.53 (95% CI = 1.48–5.57)) and PSI (OR = 5.29 (95% CI = 2.92–7.66)) independently predicted inferior NIHSS at discharge. Insular and basal ganglia lesions increased the PSD risk about four- to eight-fold.

Discussion/Conclusion:

This study identified modifiable risk factors, the management of which might reduce the negative impact PSD has on outcome.

Early-onset delirium after spontaneous intracerebral hemorrhage

I had not heard of this problem. You'll have to hope like hell that your doctor has and knows the protocol to prevent it.  

1 in 4 have delirium post stroke from this research:

Delirium – an overlooked complication of stroke

 

Early-onset delirium after spontaneous intracerebral hemorrhage

Show all authors

Federico Marrama, Maéva Kyheng, Marco Pasi, ...

First Published December 7, 2021 Research Article Find in PubMed 

https://doi.org/10.1177/17474930211059636

Article information

Abstract

Objective

This study aimed at identifying the incidence, predictors, and impact on long-term mortality and dementia of early-onset delirium in a cohort of patients with spontaneous intracerebral hemorrhage.

Methods

We prospectively recruited consecutive patients in the Prognosis of InTra-Cerebral Hemorrhage (PITCH) cohort and analyzed incidence rate of early-onset delirium (i.e. during the first seven days after intracerebral hemorrhage onset) with a competing risk model. We used a multivariable Fine-Gray model to identify baseline predictors, a Cox regression model to study its impact on the long-term mortality risk, and a Fine-Gray model adjusted for pre-specified confounders to analyze its impact on new-onset dementia.

Results

The study population consisted of 248 patients (mean age 70 years, 54% males). Early-onset delirium incidence rate was 29.8% (95% confidence interval (CI) 24.3–35.6). Multivariate analysis showed that pre-existing dementia (subhazard ratio (SHR) 2.08, 95%CI 1.32–3.32, p = 0.002), heavy alcohol intake (SHR 1.79, 95%CI 1.13–2.82, p = 0.013), and intracerebral hemorrhage lobar location (SHR 1.56, 95%CI 1.01–2.42, p = 0.049) independently predicted early-onset delirium. Median follow-up was 9.5 years. Early-onset delirium was associated with higher mortality rates during the first five years of follow-up (HR 1.52, 95%CI 1.00–2.31, p = 0.049), but did not predict new-onset dementia (SHR 1.31, 95%CI 0.60–2.87).

Conclusion

Early-onset delirium is a frequent complication after intracerebral hemorrhage; it is associated with markers of pre-existing brain vulnerability and with higher mortality risk, but not with higher dementia rates during long-term follow-up.

Keywords

Intracerebral hemorrhage, delirium, long-term outcomes, mortality, dementia

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Delirium REduction after Administration of Melatonin in acute ischemic Stroke (DREAMS): A Propensity Score Matched Analysis

I had not heard of this problem. You'll have to hope like hell that your doctor has and knows the protocol to prevent it.  

1 in 4 have delirium post stroke from this research:

Delirium – an overlooked complication of stroke

The latest here:

Delirium REduction after Administration of Melatonin in acute ischemic Stroke (DREAMS): A Propensity Score Matched Analysis

Annerose Mengel

Jan Zurloh

Christian Boßelmann

Bettina Brendel

Vera Stadler

Jennifer Sartor‐Pfeiffer

Andreas Meisel

Robert Fleischmann

Ulf Ziemann

Sven Poli

Maria‐Ioanna Stefanou

First published: 03 March 2021

https://doi.org/10.1111/ene.14792

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/ene.14792

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Abstract

Background

Post‐stroke delirium (PSD) comprises a common and severe complication after stroke. Yet, treatment options for PSD remain insufficient. We investigated whether prophylactic melatonin supplementation may be associated with reduced risk for PSD.

Methods

Consecutive patients admitted to Tübingen University Stroke Unit, Germany, with acute ischemic stroke (AIS), who underwent standard care (between August and December 2017) and patients who additionally received prophylactic melatonin (2 mg per day at night) within 24 hours of symptom onset (between August and December 2018) were included. Primary outcomes were: (i) PSD prevalence in AIS patients, (ii) PSD risk and PSD‐free survival in patients with cerebral infarction who underwent melatonin supplementation compared to propensity‐score‐matched (PSM) controls. Secondary outcomes included time of PSD‐onset and PSD‐duration.

Results

Out of 465 (81.2%) with cerebral infarction and 108 (18.8%) TIA patients, 152 (26.5%) developed PSD (median time‐to‐onset [IQR]: 16 [8,32] hours; duration 24 [8,40] hours). Higher age, cerebral infarction (rather than TIA), higher NIHSS and aphasia on admission were significant predictors of PSD. After PSM (164 melatonin‐treated patients with cerebral infarction versus 164 matched‐controls), 42 (25.6%) melatonin‐treated patients developed PSD vs. 60 (36.6%) controls (OR [95% CI]: 0.597 [0.372‐0.958], p=.032). PSD‐free survival differed significantly between groups (p=.027), favoring melatonin‐treated patients. In patients with PSD, no between‐group differences in the time of PSD‐onset and PSD‐duration were noted.

Conclusions

Patients prophylactically treated with melatonin within 24 hours of AIS onset had lower risk for PSD than patients undergoing standard care. Prospective randomized trials are warranted to corroborate these findings.

 

Delirium – an overlooked complication of stroke

If you are the 1 in 4 having delirium you better hope like hell your stroke doctor and hospital have those  delirium prevention protocols ready to use.

Delirium – an overlooked complication of stroke

10/07/2020/in ESO, Stroke Research /by Jennifer Thomsen

Delirium – an overlooked complication of stroke
By Kateriine Orav, Department of Neurology, North Estonia Medical Center, Estonia
Most doctors have encountered late night negotiations with patients who suddenly discover themselves in a bizarre reality and are convinced the only thing to do is escape. Or patients who believe the nasogastric tube is a sort of evil creature that needs to be removed. And quite often we fail to comprehend the impact and distress this condition is having on the patient. Stroke patients are a unique group of patients who can develop delirium because underlying the acute brain dysfunction characteristic of this disorder is an actual structural brain disease. Delirium has received unproportionally little attention in stroke care. Even though it is rather common, affecting approximately 1 in 4 people.¹

Detection of delirium is important for several reasons. Firstly, stroke patients who develop delirium have worse outcomes: higher inpatient and long-term mortality, longer hospitalizations and a greater degree of dependency after discharge.² In addition, the experience of delirium can be very traumatic for patients and many studies have shown an increased rate of depression and post-traumatic stress disorder after ICU delirium,³ but this has not been adequately studied in stroke patients.

However, the diagnosis of delirium is often quite difficult and even more so in stroke patients, due to prevalent language disorders, neglect, mood disturbances and cognitive impairment. Hyperactive delirium often attracts the attention of medical personnel but is 3 times less common than the hypoactive delirium subtype, which can be easily missed when the patient is perceived as cooperative and exhibits few behavioral problems.⁴
There are many factors that can increase the risk of developing post-stroke delirium. It is more common in patients with advanced age, worse pre-stroke function and cognitive impairment, more severe stroke, previous depression, use of certain medications, comorbid disorders and co-occurring infection.^1,4 In addition patients with visio-spatial neglect (which is more commonly associated with right hemispheric strokes) and any kind of visual disturbances (poor vision pre-stroke, hemianopsia) have an increased risk of delirium.^4,5
Early detection of delirium is crucial to tailor specific interventions, however there is much uncertainty about which tools to use in stroke patients. The 4-Assessment Test for delirium (4AT) and the Confusion Assessment Method-Intensive Care Unit (CAM-ICU) have been studied most and both have a high sensitivity and specificity.⁶ Without structured assessment and often serial observations delirium can be missed, especially the hypoactive subtype.⁷ The majority of delirium is detected on the first day of admission and the remainder within the next 5 days,⁸ therefore ideally patients should be assessed for delirium regularly during at least this time period.

Aiming to prevent delirium and minimizing its negative consequences should be a priority in stroke care. There is strong evidence supporting multi-component interventions to prevent delirium in patients hospitalized in medical and surgical wards and less robust evidence that they can reduce the severity of delirium.⁹ Several guidelines are dedicated to this topic in the non-stroke population.⁷ However, there is scarce evidence about the efficacy of delirium prevention interventions in stroke patients and not all interventions can be easily applied in this cohort. A few studies have shown that delirium prevention protocols were able to decrease delirium incidence and severity in stroke patients,¹⁰ as well as reduce length of hospitalization in a neuroscience ward.¹¹ Whether the reduction in delirium incidence and length would also translate into better functional outcome in stroke patients remains to be answered.

Delirium can also be considered as a marker of quality of care and delirium incidence seems to have decreased with multidisciplinary care offered in stroke units that partially overlaps with multicomponent interventions proven to reduce delirium incidence.¹ Therefore, delirium prevention, screening and management should be part of the daily routine in stroke care.  Delirium prevention protocols that are better adjusted for stroke patients with different deficits (including cognition and language) will hopefully be available in the future.

Researchers link post-right stroke delirium and spatial neglect to common brain mechanism

This is not specific enough to be of any use. What parts of the right brain damage would cause this? I had a right brain stroke, picture of damage down at the bottom of blog. Had slight spatial neglect, resolved quickly, never had delirium.   Of course followup is needed which will never occur.
https://www.eurekalert.org/pub_releases/2017-11/kf-rlp112117.php

Kessler Foundation scientists foresee potential for strategies for minimizing risks for cognitive complications after right-brain stroke

Kessler Foundation

IMAGE: Dr. Boukrina is a research scientist in Stroke Rehabilitation Research at Kessler Foundation. view more 

Credit: Kessler Foundation

East Hanover, NJ. Nov.20, 2017. Stroke researchers at Kessler Foundation have proposed a theory for the high incidence of delirium and spatial neglect after right-brain stroke. Their findings are detailed in "Disruption of the ascending arousal system and cortical attention network in post-stroke delirium and spatial neglect," which was published online ahead of print on September 27, 2017 by Neuroscience & Biobehavioral Reviews. The authors are Olga Boukrina, PhD, research scientist, and A.M. Barrett, MD, director of Stroke Rehabilitation Research at Kessler Foundation.
Delirium and spatial neglect affect approximately half of individuals with right brain stroke, increasing their risk for prolonged stays and rehospitalization. Identifying the factors associated with these often disabling conditions is the initial step toward minimizing their impact on recovery and rehabilitation. Stroke survivors with spatial neglect are more likely to develop delirium, an acute disorder of attention and cognition, suggesting that these conditions may share a common brain mechanism.
"The brain networks for spatial attention and arousal may underlie the impairments in delirium and spatial neglect," noted Dr. Boukrina. "These networks comprise ascending projections from the midbrain nuclei and integrate dorsal and ventral cortical and limbic components. We propose that right-brain stroke disproportionately impairs these cortical and limbic components, causing the lateralized deficits that characterize spatial neglect," she explained. "Spatial neglect may lower the threshold for delirium, which could account for the higher incidence of both post-stroke complications."
Further research is needed in order to identify individuals at risk soon after stroke, and develop an effective protocol for reducing the risk of these complications and their contributions to mortality and morbidity.

Statins and delirium: Is there a role?

If we are going to use statins immediately post-stroke because of this then your doctor needs to know the downside.

Simvastatin attenuates axonal injury after experimental traumatic brain injury and promotes neurite outgrowth of primary cortical neurons

The downside?

 

 Statins and delirium: Is there a role?

• Margarita Taburyanskaya,
• Tanna Hassig

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Topic

Topical Collection on Statin Drugs

Abstract

Delirium is a serious but potentially avoidable complication in critically ill patients. Various pathophysiological processes have been associated with delirium development; however, neuroinflammation hypothesis and pleiotropic effects are the reasons why HMG-CoA reductase inhibitors have been evaluated for delirium prevention. Statin therapy is associated with favorable outcomes in critically ill patients, but significant variability of results exists in patients who received these agents postoperatively. Study design methodological weaknesses, inconsistent delirium assessment, and lack of information on sedation regimens may have confounded these outcomes. Furthermore, no evidence exists on the type of statin, lipophilic or non-lipophilic, that is associated with the most benefit or when therapy with a statin should be initiated. Thus, the efficacy of HMGM-CoA reductase inhibitors on delirium prevention has not been fully established and non-pharmacological methods should remain mainstay of therapy.