Journal article
Cognitive predictors of delirium on long-term follow-up after tia and stroke: population-based cohort study
- Abstract:
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Introduction: TIA and stroke cause cognitive impairment with a typical “vascular” pattern, including prominent frontal/executive deficits. Cognitive impairment is associated with increased delirium risk and the few available data suggest that executive dysfunction is important. We therefore determined the predictive value of both severity and pattern of cognitive deficits for delirium on long-term follow-up after TIA/stroke.
Methods: Surviving TIA/stroke participants on October 1, 2013, in the Oxford Vascular Study (OXVASC) were assessed prospectively for delirium during all hospitalizations over the subsequent 6 months. Associations between OXVASC pre-admission mini-mental state examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores, and delirium during hospitalizations on follow-up were determined using logistic regression adjusted for covariates, including demographic factors, history of depression, baseline stroke severity, and admission illness severity.
Results: Among 1,565 TIA/stroke survivors, 158 patients (mean/SD age = 79.2/11.5 years) had ≥1 admission and 59 (37%) had ≥1 delirium episode. Mean/SD time between baseline TIA/stroke and admission was 4.7/3.6 years and between most recent OXVASC cognitive testing and admission was 1.7/1.8 years. MMSE and MoCA scores were associated with delirium: odds ratio (OR) = 1.16 (95% CI 1.07–1.27, p < 0.0001 per point decrease in MMSE) and OR = 1.20 (1.11–1.30, p < 0.0001 MoCA) and associations were robust to adjustment for all covariates, including stroke severity: OR = 1.11 (1.01–1.22, p = 0.03, MMSE) and OR = 1.15 (1.05–1.25, p = 0.003, MoCA). All 10 subtests on the MoCA and 4/11 on the MMSE were significantly associated with delirium with highest predictive value for frontal/executive and recall domains.
Conclusions: Cognitive impairment of increasing severity after TIA/stroke predisposed to delirium particularly deficits in frontal/executive domains and recall. Long-term risk of delirium should be considered as part of the overall cerebrovascular disease burden.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 307.5KB, Terms of use)
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- Publisher copy:
- 10.1159/000519900
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+ National Institute for Health and Care Research
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- Funder identifier:
- https://ror.org/0187kwz08
- Publisher:
- Karger Publishers
- Journal:
- Cerebrovascular Diseases More from this journal
- Volume:
- 51
- Issue:
- 3
- Pages:
- 288-295
- Place of publication:
- Switzerland
- Publication date:
- 2021-11-29
- Acceptance date:
- 2021-09-16
- DOI:
- EISSN:
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1421-9786
- ISSN:
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1015-9770
- Pmid:
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34844242
- Language:
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English
- Keywords:
- Pubs id:
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1222377
- Local pid:
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pubs:1222377
- Deposit date:
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2025-04-23
- ARK identifier:
Terms of use
- Copyright holder:
- Pendlebury et al
- Copyright date:
- 2021
- Rights statement:
- © 2021 The Author(s). Published by S. Karger AG, Basel. This article is licensed under the Creative Commons Attribution 4.0 International License (CC BY). Usage, derivative works and distribution are permitted provided that proper credit is given to the author and the original publisher.Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
- Licence:
- CC Attribution (CC BY)
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