Association of post-stroke delirium with short-term trajectories of cognition.

Abstract

Delirium could increase the risk of cognitive decline. We aimed to determine if changes in cognitive functions shortly after stroke differ between patients with and patients without delirium. We included patients who participated in the Prospective Observational Polish Study on post-stroke delirium and underwent the Montreal Cognitive Assessment (MoCA) at day 1, day 8 and 3months after stroke. Delirium was diagnosed using DSM-5 criteria. We used mixed linear regression models to characterize changes in mean adjusted MoCA scores over time. We included 402 patients (mean age: 68.9 ± 13.3years; mean NIHSS on admission: 6.2 ± 5.5; 48.8% female). Delirium occurred in 18.9% of them. Mean adjusted MoCA scores increased from day 1 to day 8 (20.48 vs 23.34, P<0.001) and then declined from day 8 to month 3 (23.34 vs 22.21, P<0.001). The rate of change in total MoCA scores from day 1 to day 8 (net effect: 0.65, 95%CI: -1.19; 2.49, P=0.489) and from day 8 to month 3 (net effect: -2.43, 95%CI: -4.84; -0.02, P=0.147) did not differ between patients with and patients without delirium. Compared with patients without delirium, those with delirium showed a greater improvement in naming, orientation and attention, accompanied by a worsening in memory from day 1 to day 8. They also experienced a greater decline in attention and orientation, along with a greater improvement in memory from day 8 to 3months. Post-stroke delirium is associated with short-term trajectories of specific cognitive domains, but not with changes in global cognition.