Session Information
Date: Saturday, November 16, 2019
Session Title: Neurological Rehabilitation Case and Research Report
Session Time: 11:15am-12:45pm
Location: Research Hub - Kiosk 5
Disclosures: Jamie L. Ott, DO: Nothing to disclose
Objective: To study the association of post-stroke delirium and spatial neglect. Delirium increases mortality, length of hospital stay, and adversely affects functional outcomes. Previous studies suggest the incidence of delirium may be nearly doubled in right-brain injuries. Similarly, spatial neglect is more common and more severe after right-brain strokes. We hypothesized that higher incidence of both delirium and spatial neglect after right-brain strokes is due to disruption of right-dominant attention and arousal networks. To test this hypothesis, we examined data from consecutive unilateral stroke patients evaluated with validated clinical assessments. The 3-minute diagnostic interview for confusion assessment method (3D-CAM) was used to measure delirium and the Kessler Foundation Neglect Assessment Process (KF-NAP) was used to study spatial neglect.
Design: Retrospective chart review
Setting: Inpatient acute rehabilitation
Participants: 691 stroke patients
Interventions: Not applicable
Main Outcome Measures: Incidence of delirium in right-brain versus left-brain stroke patients, KF-NAP score among delirium positive patients with left vs. right stroke, odds ratio of right-brain stroke patients having delirium when positive for spatial neglect. For the purpose of this analysis, positive and unscored 3D-CAM populations were treated as positive.
Results: The incidence of delirium was higher in left-brain strokes, primarily due to greater number of unscored cases (22% vs. 12%, OR=2.39, P<.001). Among 3D-CAM positive cases, spatial neglect severity was greater in right-brain strokes (M right = 8.17, SD = 8.14; M left = 5.43, SD = 7.97, t(137)=1.91, P=.059). Importantly, there was significantly higher risk of delirium in right-brain stroke patients with spatial neglect, (20% vs. 6%, OR= 2.70, P<.001).
Conclusions: The results suggest that the association between right-brain stroke and delirium may be mediated by spatial neglect. Early interventions for spatial inattention may help to prevent delirium and its functional consequences. Furthermore, aphasia and dysarthria may confound verbal delirium assessment in left-stroke patients. Future prospective studies are needed to replicate these results.
Level of Evidence: Level III
To cite this abstract in AMA style:
Ott JL, Boukrina O, Darji JY. Association of Delirium and Spatial Neglect in Right-Brain Stroke Patients [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/association-of-delirium-and-spatial-neglect-in-right-brain-stroke-patients/. Accessed May 15, 2025.« Back to AAPM&R Annual Assembly 2019
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/association-of-delirium-and-spatial-neglect-in-right-brain-stroke-patients/