The prevalence or incidence of delirium in acute stroke has been reported to vary from 10% to 48%. Delirium in acute stroke is related to poor patient outcomes. Multiple risk factors of delirium in acute stroke have been suggested in previous studies but varied. It is important to assess delirium in acute stroke to improve patient care. 

This is a prospective observational study. We screened delirium daily for acute ischemic stroke patients aged 18 or older using Confusion Assessment Method for the ICU and 3-minute Diagnostic Confusion Assessment Method on the wards starting within 48 hours after recognition of stroke until post-stroke day 7 or discharge. Data on patient characteristics were collected through chart review and analyzed using multivariate logistic regression. 

Of 74 patients included in the study, 29 (39.1%) developed delirium. The mean age and NIH stroke scale (NIHSS) at presentation were higher in delirium group than non-delirium group (69.4 ± 2.76 vs 65.1 ± 2.00, 13.0 ± 1.30 vs 7.1 ± 1.00). Also, delirium group showed higher rates of prolonged ICU stay, presence of aphasia, embolic stroke, bilateral cerebral involvement, history of previous stroke and cognitive decline compared with non-delirium group. In contrast, more patients in non-delirium group received intravenous antithrombotic therapy. Higher NIHSS was positively associated with development of delirium (OR=1.26, 95% CI 1.10 to 1.44, P < 0.01) while intravenous antithrombotic therapy was negatively associated(OR=0.04, 95% CI 0.00 to 0.35, P < 0.01). 

This pilot study demonstrated high incidence of delirium among acute ischemic stroke patients at UNMC. Further study with a larger sample size is required to identify risk factors of delirium in this patient population and proactively manage delirium for better outcomes.