Acute Confusional State at Early Stage of Stroke

作者：Kara Harun; Bicakci Sebnem^*; Over Mehmet Fahri; Calis Nazif; Bicakci Yunus Kenan; Ozeren Ali; Bozdemir Hacer

来源：Journal of Neurological Sciences-Turkish, 2013, 30(1): 21-29.

• Acute confusional state (ACS)
• Cholinergic Hyperintensities Pathway Scale (CHIPS)
• Delirium Rating Scale
• Informant Questionnaire on Cognitive Decline in Elderly (IQCODE) scoring
• National Institute of Health Stroke Scale (NIHSS)

Acute confusional state is a change of mental status with sudden onset and fluctuating course. This study was aimed at determining the frequency of ACS that appears at early (acute) stage of stroke, its predisposing factors, and its impact on prognosis.
Material and Method: 150 cases were included in this study which was performed prospectively. ACS was diagnosed on the basis of DSM-IV criteria and of Delirium Rating Scale. Pre-stroke cognitive functions were evaluated according to Informant Questionnaire on Cognitive Decline in Elderly scoring. White matter hyperintensities detected on cerebral magnetic resonance imaging were classified according to Cholinergic Hyperintensities Pathway Scale scoring.
Results: The rate of ACS was determined as 28% in cases who experienced stroke. Advanced age, presence of cognitive decline, use of anticholinergic drugs during pre-stroke period and in acute stage, ischemic heart disease, hemorrhagic stroke, concomitant, infectious and metabolic problems, concurrent neglect and/or anosognosia phenomenon, advanced stage leukoaraiosis, high National Institute of Health Stroke Scale, Colinergic Hyperintensities Pathway Scale and Informant Questionnaire on Cognitive Decline in Elderly scores increase the possibility of entering acute confusional state. Functional and vital prognoses follow a poorer course in those who enter ACS than in those who do not.
Conclusion: Cases who experienced stroke should be monitored closely, particularly in acute stage, with respect to cognitive changes. In the acute stage of stroke, diagnosing and treating metabolic and infectious problems that may cause ACS, and avoiding as much as possible anticholinergic medications is (are) important in terms of preventing the manifestation.

• 出版日期2013