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Psychosomatics. 2017 Jan - Feb;58(1):19-27. doi: 10.1016/j.psym.2016.07.004. Epub 2016 Aug 5.

Agitation, Delirium, and Cognitive Outcomes in Intracerebral Hemorrhage.

Author information

1
Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL.
2
Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL.
3
Department of Medical Social Sciences and PROMIS Statistical Center, Northwestern University, Feinberg School of Medicine, Chicago, IL.
4
Department of Center for Healthcare Studies, Northwestern University, Feinberg School of Medicine, Chicago, IL.
5
Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL; Department of Medical Social Sciences and PROMIS Statistical Center, Northwestern University, Feinberg School of Medicine, Chicago, IL; Department of Center for Healthcare Studies, Northwestern University, Feinberg School of Medicine, Chicago, IL. Electronic address: a-naidech@northwestern.edu.

Abstract

BACKGROUND:

Delirium predicts higher long-term cognitive morbidity. We previously identified a cohort of patients with spontaneous intracerebral hemorrhage and delirium and found worse outcomes in health-related quality of life (HRQoL) in the domain of cognitive function.

OBJECTIVE:

We tested the hypothesis that agitation would have additional prognostic significance on later cognitive function HRQoL.

METHODS:

Prospective identification of 174 patients with acute intracerebral hemorrhage, measuring stroke severity, agitation, and delirium, with a standardized protocol and measures. HRQoL was assessed using the Neuro-QOL at 28 days, 3 months, and 1 year. Functional outcomes were measured with the modified Rankin Scale.

RESULTS:

Among the 81 patients with HRQoL follow-up data available, patients who had agitation and delirium had worse cognitive function HRQoL scores at 28 days (T scores for delirium with agitation 20.9 ± 7.3, delirium without agitation 30.4 ± 16.5, agitation without delirium 36.6 ± 17.5, and neither agitated nor delirious 40.3 ± 15.9; p = 0.03) and at 1 year (p = 0.006). The effect persisted in mixed models after correction for severity of neurologic injury, age, and time of assessment (p = 0.0006) and was not associated with medication use, seizures, or infection.

CONCLUSIONS:

The presence of agitation with delirium in patients with intracerebral hemorrhage may predict higher risk of unfavorable cognitive outcomes up to 1 year later.

KEYWORDS:

cognition disorders; delirium; hyperkinesis; psychomotor agitation; quality of life; stroke.

PMID:
27665997
PMCID:
PMC5836544
DOI:
10.1016/j.psym.2016.07.004
[Indexed for MEDLINE]
Free PMC Article

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