Lisa J Rosenthal1, Brandon A Francis2, Jennifer L Beaumont3, David Cella3, Michael D Berman3, Matthew B Maas2, Eric M Liotta2, Robert Askew4, Andrew M Naidech5. 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.
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.
Authors: Frances M Yang; Edward R Marcantonio; Sharon K Inouye; Dan K Kiely; James L Rudolph; Michael A Fearing; Richard N Jones Journal: Psychosomatics Date: 2009 May-Jun Impact factor: 2.386
Authors: David J Meagher; Maeve Leonard; Sinead Donnelly; Marion Conroy; Dimitrios Adamis; Paula T Trzepacz Journal: J Psychosom Res Date: 2011-07-02 Impact factor: 3.006
Authors: Jane S Saczynski; Edward R Marcantonio; Lien Quach; Tamara G Fong; Alden Gross; Sharon K Inouye; Richard N Jones Journal: N Engl J Med Date: 2012-07-05 Impact factor: 91.245
Authors: David J Meagher; Maeve Leonard; Sinead Donnelly; Marion Conroy; Dimitrios Adamis; Paula T Trzepacz Journal: J Psychosom Res Date: 2012-01-09 Impact factor: 3.006
Authors: Ayumi K Shintani; Timothy D Girard; Svetlana K Eden; Patrick G Arbogast; Karel G M Moons; E Wesley Ely Journal: Crit Care Med Date: 2009-11 Impact factor: 7.598
Authors: P M Vespa; K O'Phelan; M Shah; J Mirabelli; S Starkman; C Kidwell; J Saver; M R Nuwer; J G Frazee; D A McArthur; N A Martin Journal: Neurology Date: 2003-05-13 Impact factor: 9.910
Authors: D Cella; J-S Lai; C J Nowinski; D Victorson; A Peterman; D Miller; F Bethoux; A Heinemann; S Rubin; J E Cavazos; A T Reder; R Sufit; T Simuni; G L Holmes; A Siderowf; V Wojna; R Bode; N McKinney; T Podrabsky; K Wortman; S Choi; R Gershon; N Rothrock; C Moy Journal: Neurology Date: 2012-05-09 Impact factor: 9.910
Authors: Andrew M Naidech; Jennifer Beaumont; Kathryn Muldoon; Eric M Liotta; Matthew B Maas; Matthew B Potts; Babak S Jahromi; David Cella; Shyam Prabhakaran; Jane L Holl Journal: Crit Care Med Date: 2018-09 Impact factor: 7.598
Authors: Matthew B Maas; Bryan D Lizza; Minjee Kim; Sabra M Abbott; Maged Gendy; Kathryn J Reid; Phyllis C Zee Journal: Crit Care Med Date: 2020-06 Impact factor: 7.598
Authors: Jennifer R Meeks; Arvind B Bambhroliya; Sunil A Sheth; Babar Khan; Arjen J C Slooter; E Wesley Ely; Charles C Miller; Jon E Tyson; Louise D McCullough; Sean I Savitz; Farhaan S Vahidy Journal: Crit Care Explor Date: 2020-06-09
Authors: Mayur B Patel; Josef Bednarik; Patricia Lee; Yahya Shehabi; Jorge I Salluh; Arjen J Slooter; Kate E Klein; Yoanna Skrobik; Alessandro Morandi; Peter E Spronk; Andrew M Naidech; Brenda T Pun; Fernando A Bozza; Annachiara Marra; Sayona John; Pratik P Pandharipande; E Wesley Ely Journal: Crit Care Med Date: 2018-11 Impact factor: 7.598
Authors: Carl Moritz Zipser; Jeremy Deuel; Jutta Ernst; Maria Schubert; Michael Weller; Roland von Känel; Soenke Boettger Journal: J Neurol Date: 2019-09-13 Impact factor: 4.849