Abstract Details

Title In-hospital Delirium and Long-Term Cognitive Outcomes among Patients with Ischemic Stroke: A population-based cohort analysis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-021

Objective To examine the prospective incident risk of mild cognitive impairment or dementia (MCID) among ischemic stroke (IS) patients who experienced in-hospital delirium in a large multi-state population-based cohort.

Background Evidence of association between delirium during initial hospitalization of IS patients, and development of long-term MCID is lacking.

Design/Methods We utilized NY, CA, and FL (2005 – 2014) State Inpatient and Emergency Department Databases, and established a cohort by selecting MCID free patients with a primary diagnosis of IS (ICD-9: 433.x1, 434.x1, 436) during a 2yr period. Delirium during the initial IS event was tagged using a validated algorithm with high specificity for the confusion assessment method. The cohort was followed for MCID diagnoses. Patients that died within 90 days of initial IS event were excluded. We conducted time-to-event analyses and report cumulative incidence, 95% Confidence Interval (CI) and hazard ratios (HR) for risk of MCID among IS patients with and without delirium.

Results

A total of 133,815 IS patients (age: 70.5, female: 51.7%, white: 65.5%) were followed for up to 8yrs, resulting in 357,500 person-years. Patients who experienced delirium were significantly older and had a higher comorbidity burden. A significantly smaller proportion of delirium patients underwent IV or IA thrombolysis. Cumulative incidence (95% CI) for development of MCID was significantly higher among delirium patients (9.01, 8.32 – 9.74) as compared to non-delirium patients (3.99, 3.93 – 4.06). Likewise, the HR for MCID among delirium patients was statistically significant (1.86, 1.71 – 2.02) in the fully adjusted Cox proportional model.

Conclusions

In-hospital delirium was independently associated with a higher risk of developing MCID in this large population-based cohort. Further investigation is warranted to elucidate the mechanistic basis for the role of delirium in long-term cognitive decline among IS patients.

Authors/Disclosures
PRESENTER	No disclosure on file
Jennifer Meeks	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Sunil Sheth, MD (University of Texas At Houston)	Dr. Sheth has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Penumbra. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Imperative Care.
Louise D. McCullough, MD, PhD (McGovern Medical School, UTHealth)	The institution of Dr. McCullough has received research support from NIH. The institution of Dr. McCullough has received research support from American Heart Association.
James C. Grotta, MD, FAAN (Memorial Hermann Hospital Life Flight)	Dr. Grotta has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Frazer Ltd. Dr. Grotta has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Haemonetics. Dr. Grotta has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Acticor. Dr. Grotta has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Prolong Pharma. Dr. Grotta has received publishing royalties from a publication relating to health care. Dr. Grotta has received publishing royalties from a publication relating to health care.
	No disclosure on file
Sean I. Savitz, MD	Dr. Savitz has nothing to disclose.
Farhaan S. Vahidy, MBBS, PhD (Houston Methodist)	Dr. Vahidy has nothing to disclose.

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