Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Neurology
Published in: BMC Neurology 1/2015

Open Access 01-12-2015 | Study protocol

PRospective Observational POLIsh Study on post-stroke delirium (PROPOLIS): methodology of hospital-based cohort study on delirium prevalence, predictors and diagnostic tools

Authors: Elzbieta Klimiec, Tomasz Dziedzic, Katarzyna Kowalska, Aleksandra Szyper, Joanna Pera, Paulina Potoczek, Agnieszka Slowik, Aleksandra Klimkowicz-Mrowiec

Published in: BMC Neurology | Issue 1/2015

Login to get access

Abstract

Background

Between 10 % to 48 % of patients develop delirium in acute phase of stroke. Delirium determinants and its association with other neuropsychiatric disturbances in stroke are poorly understood. The wildly accepted predictive model of post-stroke delirium is still lacking.

Methods/design

This is a prospective, observational, single-center study in patients with acute phase of stroke. We aim to include 750 patients ≥18 years with acute stroke or transient ischemic attack admitted to the stroke unit within 48 hours after stroke onset. The goals of the study are: 1) to determine frequency of delirium and subsyndromal delirium in Polish stroke patients within 7 days after admission to the hospital; 2) to determine factors associated with incidence, severity and duration of delirium and subsyndromal delirium and to create a predictive model for post-stroke delirium; 3) to determine the association between delirium and its cognitive, psychiatric, behavioral and functional short and long-term consequences; 4) to validate scales used for delirium diagnosis in stroke population.
Patients will be screened for delirium on daily basis. The diagnosis of delirium will be based on DSM-V criteria. Abbreviated version of Confusion Assessment Method and Confusion Assessment Method for the Intensive Care Unit will be used for delirium and sub-delirium screening. Severity of delirium symptoms will be assessed by Delirium Rating Scale Revised 98 and Cognitive Test for Delirium. Patients who survive will undergo extensive neuropsychological, neuropsychiatric and functional assessment 3 and 12 months after the stroke.

Discussion

This study is designed to provide information on clinical manifestation, diagnostic methods and determinants of delirium spectrum disorders in acute stroke phase and their short and long-term consequences. Collected information allow us to create a predictive model for post-stroke delirium.
Literature
1.
Oldenbeuving AW, De Kort PLM, Jansen BPW, Roks G, Kappelle LJ. Delirium in acute stroke: a review. Int J Stroke. 2007;2:270–5.CrossRefPubMed
2.
Shi Q, Presutti R, Selchen D, Saposnik G. Delirium in acute stroke: a systematic review and meta-analysis. Stroke. 2012;43:645–9.CrossRefPubMed
3.
Oldenbeuving AW, De Kort PLM, Jansen BPW, Algra A, Kappelle LJ, Roks G. Delirium in the acute phase after stroke: incidence, risk factors, and outcome. Neurology. 2011;76:993–9.CrossRefPubMed
4.
Sheng AZA, Shen QQ, Cordato DD, Zhang YYY, Chan DKDY. Delirium within three days of stroke in a cohort of elderly patients. J Am Geriatr Soc. 2006;54:1192–8.CrossRefPubMed
5.
Naidech AM, Beaumont JL, Rosenberg NF, Maas MB, Kosteva AR, Ault ML, et al. Intracerebral hemorrhage and delirium symptoms. Length of stay, function, and quality of life in a 114-patient cohort. Am J Respir Crit Care Med. 2013;188:1331–7.CrossRefPubMedPubMedCentral
6.
Henon H, Lebert F, Durieu I, Godefroy O, Lucas C, Pasquier F, et al. Confusional state in stroke: relation to preexisting dementia, patient characteristics, and outcome. Stroke. 1999;30:773–9.CrossRefPubMed
7.
Van Rijsbergen MW, Oldenbeuving AW, Nieuwenhuis-Mark RE, Nys GM, Las SG, Roks G, et al. Delirium in acute stroke: a predictor of subsequent cognitive impairment?:a two-year follow-up study. J Neurol Sci. 2010;306:138–42.CrossRef
8.
Dahl MH, Rønning OM, Thommessen B. Delirium in acute stroke–prevalence and risk factors. Acta Neurol Scand Suppl. 2009;190:39–43.
9.
McManus J, Pathansali R, Stewart R, Macdonald A, Jackson S. Delirium post-stroke. Age Ageing. 2007;36:613–8.CrossRefPubMed
10.
Carin-Levy G, Mead GE, Nicol K, Rush R, Van Wijck F. Delirium in acute stroke: screening tools, incidence rates and predictors: a systematic review. J Neurol. 2012;259:1590–9.CrossRefPubMed
11.
Caeiro L, Ferro JM, Albuquerque R, Figueira ML. Delirium in the first days of acute stroke. J Neurol. 2004;251:171–8.CrossRefPubMed
12.
Oldenbeuving AW, De Kort PL, Van E, Van der Sluijs JF, Kappelle LJ, Roks G. An early prediction of delirium in the acute phase after stroke. J Neurol Neurosurg Psychiatry. 2014;85:431–4.CrossRefPubMed
13.
Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. JAMA. 1996;275:852–7.CrossRefPubMed
14.
Blazer DG, Van Nieuwenhuizen AO. Evidence for the diagnostic criteria of delirium. Curr Opin Psychiatry. 2012;25:239–43.CrossRefPubMed
15.
Meagher DJ, Morandi A, Inouye SK, Ely W, Adamis D, Maclullich AJ, et al. Concordance between DSM-IV and DSM-5 criteria for delirium diagnosis in a pooled database of 768 prospectively evaluated patients using the delirium rating scale-revised-98. BMC Med. 2014;12:164.CrossRefPubMedPubMedCentral
16.
Hackett ML, Yapa C, Parag V, Anderson CS. Frequency of depression after stroke: a systematic review of observational studies. Stroke. 2005;36:1330–40.CrossRefPubMed
17.
Loong CK, Kenneth NKC, Paulin ST. Post-stroke depression: outcome following rehabilitation. Aust N Z J Psychiatry. 1995;29:609–14.CrossRefPubMed
18.
Campbell Burton CA, Murray J, Holmes J, Astin F, Greenwood D, Knapp P. Frequency of anxiety after stroke: a systematic review and meta-analysis of observational studies. Int J Stroke. 2013;8:545–59.CrossRefPubMed
19.
Choi-Kwon S, Han SW, Kwon SU, Kim JS. Poststroke fatigue: characteristics and related factors. Cerebrovasc Dis. 2005;19:84–90.CrossRefPubMed
20.
Van Dalen JW, Moll Van Charante EP, Nederkoorn PJ, Van Gool WA, Richard E. Poststroke apathy. Stroke. 2013;44:851–60.CrossRefPubMed
21.
Hackett ML, Köhler S, O’Brien JT, Mead GE. Neuropsychiatric outcomes of stroke. Lancet Neurol. 2014;13:525–34.CrossRefPubMed
22.
Klimkowicz A, Dziedzic T, Slowik A, Szczudlik A. Incidence of pre-and poststroke dementia: cracow stroke registry. Dement Geriatr Cogn Disord. 2002;14:137–40.CrossRefPubMed
23.
Jorm AF, Korten AE. Assessment of cognitive decline in the elderly by informant interview. Br J Psychiatry. 1988;152:209–13.CrossRefPubMed
24.
Harrison JK, Fearon P, Noel-Storr AH, McShane R, Stott DJ, Quinn TJ. Informant questionnaire on cognitive decline in the elderly (IQCODE) for the diagnosis of dementia within a general practice (primary care) setting. Cochrane Database Syst Rev. 2014;7:CD010771.PubMed
25.
Carnahan RM, Lund BC, Perry PJ, Pollock BG, Culp KR. The anticholinergic drug scale as a measure of drug-related anticholinergic burden: associations with serum anticholinergic activity. J Clin Pharmacol. 2006;46:1481–6.CrossRefPubMed
26.
Han JH, Wilson A, Vasilevskis EE, Shintani A, Schnelle JF, Dittus RS, et al. Diagnosing delirium in older emergency department patients: validity and reliability of the delirium triage screen and the brief confusion assessment method. Ann Emerg Med. 2013;62:457–65.CrossRefPubMedPubMedCentral
27.
Inouye SK, Van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990;113:941–8.CrossRefPubMed
28.
Ely EWE, Inouye SK, Bernard GR, Gordon S, Francis J, May L, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001;286:2703–10.CrossRefPubMed
29.
Trzepacz PT, Mittal D, Torres R, Kanary K, Norton J, Jimerson N. Validation of the delirium rating scale-revised-98: comparison with the delirium rating scale and the cognitive test for delirium. J Neuropsychiatry Clin Neurosci. 2001;13:229–42.CrossRefPubMed
30.
Hart RP, Levenson JL, Sessler CN, Best AM, Schwartz SM, Rutherford LE. Validation of a cognitive test for delirium in medical ICU patients. Psychosomatics. 1996;37:533–46.CrossRefPubMed
31.
Meagher DJ, Moran M, Raju B, Gibbons D, Donnelly S, Saunders J, et al. Motor symptoms in 100 patients with delirium versus control subjects: comparison of subtyping methods. Psychosomatics. 2008;49:300–8.CrossRefPubMed
32.
Meagher D, Adamis D, Leonard M, Trzepacz P, Grover S, Jabbar F, et al. Development of an abbreviated version of the delirium motor subtyping scale (DMSS-4). Int Psychogeriatr. 2014;26:693–702.CrossRefPubMed
33.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.
34.
Cole MG, McCusker J, Voyer P, Monette J, Champoux N, Ciampi A, et al. Subsyndromal delirium in older long-term care residents: incidence, risk factors, and outcomes. J Am Geriatr Soc. 2011;59:1829–36.CrossRefPubMed
35.
Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53:695–9.CrossRefPubMed
36.
Dubois B, Slachevsky A, Litvan I, Pillon B. The FAB: a Frontal Assessment Battery at bedside. Neurology. 2000;55:1621–6.CrossRefPubMed
37.
Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994;44:2308–14.CrossRefPubMed
38.
39.
Marin RS, Biedrzycki RC, Firinciogullari S. Reliability and validity of the apathy evaluation scale. Psychiatry Res. 1991;38:143–62.CrossRefPubMed
40.
Kvaal K, Ulstein I, Nordhus IH, Engedal K. The spielberger state-trait anxiety inventory (STAI): the state scale in detecting mental disorders in geriatric patients. Int J Geriat Psychiatry. 2005;20:629–34.CrossRef
41.
Buss AH, Durkee A. An inventory for assessing different kinds of hostility. J Consult Psychol. 1957;21:343–9.CrossRefPubMed
42.
Mattis S. Mental status examination for organic mental syndrome in the elderly patients. In: Bellak L, Karasu TB, editors. Geriatric psychiatry: a handbook for psychiatrists and primary care physicians. New York, NY: Grune & Stratton; 1976. p. 77–12.
43.
Reitan RM. Validity of the trail making test as on indicator of organic brain damage. Percept Mot Skills. 1958;8:271–6.CrossRef
44.
Lezak MD. Neuropsychological assessment. 2nd ed. New York: Oxford Univeristy Press; 1982.
45.
Sivakumar L, Kate M, Jeerakathil T, Camicioli R, Buck B, Butcher K. Serial montreal cognitive assessments demonstrate reversible cognitive impairment in patients with acute transient ischemic attack and minor stroke. Stroke. 2014;45:1709–15.CrossRefPubMed
46.
Pendlebury ST, Welch SJV, Cuthbertson FC, Mariz J, Mehta Z, Rothwell PM. Telephone assessment of cognition after transient ischemic attack and stroke: modified telephone interview of cognitive status and telephone Montreal cognitive assessment versus face-to-face Montreal cognitive assessment and neuropsychological battery. Stroke. 2013;44:227–9.CrossRefPubMed
47.
48.
Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist. 1969;9:179–86.CrossRefPubMed
49.
Linn BS, Linn MW, Gurel L. Cumulative illness rating scale. J Am Ger Society. 1968;16:622–6.CrossRef
50.
Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36:309–32.CrossRefPubMed
51.
52.
Bamford J, Sandercock P, Dennis M, Burn J, Warlow C. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet. 1991;337:1521–6.CrossRefPubMed
53.
Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in acute stroke treatment. Stroke. 1993;24:35–41.CrossRefPubMed
Metadata
Title
PRospective Observational POLIsh Study on post-stroke delirium (PROPOLIS): methodology of hospital-based cohort study on delirium prevalence, predictors and diagnostic tools
Authors
Elzbieta Klimiec
Tomasz Dziedzic
Katarzyna Kowalska
Aleksandra Szyper
Joanna Pera
Paulina Potoczek
Agnieszka Slowik
Aleksandra Klimkowicz-Mrowiec
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2015
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-015-0351-z

Other articles of this Issue 1/2015

BMC Neurology 1/2015 Go to the issue

Case report

When battery exhaustion lets the lame walk: a case report on the importance of long-term stimulator monitoring in deep brain stimulation

Research article

Validation of NINDS-CSN neuropsychological battery for vascular cognitive impairment in Chinese stroke patients

Research article

May clinical neurophysiology help to predict the recovery of neurological early rehabilitation patients?

Study protocol

The PANGAEA study design – a prospective, multicenter, non-interventional, long-term study on fingolimod for the treatment of multiple sclerosis in daily practice

Research article

Enterprise stent for the treatment of symptomatic intracranial atherosclerotic stenosis: an initial experience of 44 patients

Case report

Pathological laughter as prodromal manifestation of transient ischemic attacks—case report and brief review