Clinical course and features of treatment of patients with ischemic stroke complicated by acute delirium

Authors

  • T.S. Zahranychnyi Shupyk National University of Public Health of Ukraine, Kyiv, Ukraine
  • S.M. Nedashkivsky Shupyk National University of Public Health of Ukraine, Kyiv, Ukraine
  • O.A. Halushko Shupyk National University of Public Health of Ukraine, Kyiv, Ukraine

DOI:

https://doi.org/10.22141/2224-0586.17.2.2021.230630

Keywords:

acute ischemic stroke, complications, delirium, intensive care

Abstract

Delirium is a severe, multifactorial psycho-neurological disorder caused by certain substances, as well as factors and mediators that destroy neurons in the cerebral cortex. Delirium is more likely to develop after intracerebral hemorrhage, large-scale acute ischemic stroke, and left-sided stroke. The causes of delirium after stroke are insufficiently studied. There is no consensus on the best interventions for the prevention and treatment of acute delirium after stroke. The article analyzes the literature data on the clinical course and treatment of acute ischemic stroke complicated by delirium, highlights modern approaches to intensive care.

References

Українсько-латинсько-англійський медичний енциклопедичний словник. Укл.: Л.І. Петрук, І.М. Головко. К.: ВСВ «Медицина», 2015. 968 с.

Ely E.W., Shintani A., Truman B., Speroff T., Gordon S.M., Harrell F.E. Jr, Inouye S.K., Bernard G.R., Dittus R.S. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004 Apr 14. 291(14). 1753-62.

Barr J., Fraser G.L., Puntillo K., Ely E.W., Gélinas C., Dasta J.F., Davidson J.E., Devlin J.W., Kress J.P., Joffe A.M., Coursin D.B., Herr D.L., Tung A., Robinson B.R., Fontaine D.K., Ramsay M.A., Riker R.R., Sessler C.N., Pun B., Skrobik Y., Jaeschke R.; American College of Critical Care Medicine. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit. Care Med. 2013 Jan. 41(1). 263-306.

Ely Ew., Margolin R., Francis J. et al. Evaluation of delirium in critically ill patients: Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit. Care Med. 2001 Jul. 29(7). 1370-9.

Irene Mansutti, Luisa Saiani, Alvisa Palese. Detecting delirium in patients with acute stroke: a systematic review of test accuracy. BMC Neurology. 2019. 19. 310.

Mansutti I., Saiani L., Palese A. Delirium in patients with ischaemic and haemorrhagic stroke: findings from a scoping review. Eur. J. Cardiovasc. Nurs. 2019 Aug. 18(6). 435-448. doi: 10.1177/1474515119846226.

McManus J., Pathansali R., Stewart R., Macdonald A., Jackson S. Delirium post-stroke. Age Ageing. 2007 Nov. 36(6). 613-8.

Potter J., George J. Guideline Development Group. The prevention, diagnosis and management of delirium in older people: concise guidelines. Clin. Med. (Lond.). 2006 May-Jun. 6(3). 303-8.

Ferro J.M., Caeiro L., Verdelho A. Delirium in acute stroke. Curr. Opin. Neurol. 2002. 15. 51-55.

White S. The neuropathogenesis of delirium. Rev. Clin. Gerontol. 2002. 12. 62-7.

Trzepacz P.T. Is there a common neural pathway in delirium? Focus on acetylcholine and dopamine. Semin. Clin. Neuropsychiatry. 2000. 5. 132-48.

Lindsesay J., Rockwood K., Macdonald A. Delirium in Old Age, Chapter 4. Oxford: Oxford University Press, 2002.

Han L., McCusker J., Cole M. et al. Use of medications with anticholinergic effect predicts clinical severity of delirium symptoms in older medical inpatients. Arch. Intern. Med. 2001. 161. 1099-55.

Sanford A.M. Lewy Body Dementia. Clin. Geriatr. Med. 2018 Nov. 34(4). 603-615. doi: 10.1016/j.cger.2018.06.007.

Kaufer D.I., Catt K.E., Lopez O.L. et al. Dementia with Lewy bodies: response of delirium-like features to donepezil. Neurology. 1998. 51. 1512-13.

Flacker M.L., Cummings V., Mach J.R. Jr et al. The association of low serum anticholinergic activity with delirium in elderly medical inpatients. Am. J. Psychiatry. 1998. 6. 31-41.

Itil T., Fink M. Anticholinergic drug-induced delirium: expe-rimental modification, quantitative EEG and behavioural correlations. J. Nerv. Ment. Dis. 1966. 143. 492-507.

Ramírez-Bermúdez J., Perez-Neri I., Montes S., Nente F., Ramirez-Abascal M., Carrillo-Mezo R. et al. Dopaminergic Hyperactivity in Neurological Patients with Delirium. Arch. Med. Res. 2020 Feb 1. 50(8). 477-483. doi: 10.1016/j.arcmed.2019.11.002.

Neufeld K.J., Yue J., Robinson T.N., Inouye S.K., Needham D.M. Antipsychotic Medication for Prevention and Treatment of Delirium in Hospitalized Adults: A Systematic Review and Meta-Analysis. J. Am. Geriatr. Soc. 2016 Apr. 64(4). 705-14. doi: 10.1111/jgs.14076.

Caeiro L., Ferro J.M., Claro M.I. et al. Delirium in acute stroke: a preliminary study of the role of anticholinergic medications. Eur. J. Neurol. 2004. 11. 699-704.

Fong T.G., Bogardus S.T., Daftary A. et al. Cerebral changes in older patients using 99m Tc HMPAO SPECT. J. Gerontol. A: Biol. Sci. Med. Sci. 2006. 61. 1294-9.

Gustafson Y., Olsson T., Asplund K. et al. Acute confusional state (delirium) soon after stroke is associated with Hypercortisolism. Cerebrovasc. Dis. 1993. 3. 33-8.

Mitasova A., Kostalova M., Bednarik J. et al. Poststroke delirium incidence and outcomes: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit. Care Med. 2012 Feb. 40(2). 484-90.

Ryan D.J., O’Regan N.A., Caoimh R.Ó., Clare J., O’Connor M., Leonard M. et al. Delirium in an adult acute hospital population: predictors, prevalence and detection. BMJ Open. 2013 Jan 7. 3(1). e001772. doi: 10.1136/bmjopen-2012-001772.

Young J., Inouye S. Delirium in older people. BMJ. 2007. 334. 842-6.

Галушко О.А., Тріщинська М.А., Заграничний Т.С. Делірій у хворих на гострий інсульт: особливості діагностики й лікування. Медицина невідкладних станів. 2020. 3. 19-24.

Caeiro L., Ferro J., Albuquerque R. et al. Delirium in the first days of acute stroke. J. Neurol. 2004. 251. 171-8.

Sheng A.Z., Shen Q., Cordato D. et al. Delirium within three days of stroke in a cohort of elderly patients. JAGS. 2006. 54. 1192-8.

Поліщук М.Є., Галушко О.А., Гуменюк М.І., Тріщинська М.А. Інфузійна терапія в неврології і нейрохірургії. К.: Книга-плюс, 2020. 304 с.

Potter J., George J. Guideline Development Group. The prevention, diagnosis and management of delirium in older people: concise guidelines. Clin. Med. (Lond.). 2006. May-Jun. 6(3). 303-8.

Галушко О.А. Особливості виникнення та перебігу електролітних порушень в гострий період інсульту у хворих на цукровий діабет. Медицина неотложных состояний. 2017. 1(80). 87-92.

Pereira J.V., Sanjanwala R.M., Mohammed M.K., Le M.L., Arora R.C. Dexmedetomidine versus propofol sedation in reducing delirium among older adults in the ICU: A systematic review and meta-analysis. Eur. J. Anaesthesiol. 2020 Feb. 37(2). 121-131. doi: 10.1097/EJA.0000000000001131.

Zaubler T.S., Murphy K., Rizzuto L., Santos R., Skotzko C., Giordano J. et al. Quality improvement and cost savings with multicomponent delirium interventions: replication of the Hospital Elder Life Program in a community hospital. Psychosomatics. 2013 May-Jun. 54(3). 219-26. doi: 10.1016/j.psym.2013.01.010.

Савин И.А., Фокин М.С., Лубнин А.Ю. Рекомендации по интенсивной терапии у пациентов с нейрохирургической патологией (пособие для врачей). М.: ООО «ИПК «Индиго», 2006. 224 с.

Published

2021-05-24

Issue

Section

Scientific Review