Journal CME, September 2023: Association of delirium and spatial neglect in patients with right-hemisphere stroke-Journal CME, September 2023: Association of delirium and spatial neglect in patients with right-hemisphere stroke

Journal CME, September 2023: Association of delirium and spatial neglect in patients with right-hemisphere stroke

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The study examines the association between delirium and spatial neglect in patients with right-hemisphere stroke during acute inpatient rehabilitation. Delirium, defined as an acute decline in cognitive functioning, and spatial neglect, a significant deficit in unilateral spatial processing, both adversely affect functional outcomes and prolong hospital stays. The hypothesis was that patients with right-hemisphere stroke exhibiting spatial neglect are at higher risk of delirium.<br /><br />Data from 626 unilateral stroke patients were analyzed using the 3-minute diagnostic interview for confusion assessment method (3D-CAM) for delirium and the Catherine Bergego Scale (CBS) administered via the Kessler Foundation Neglect Assessment Process (KF-NAP) for spatial neglect. The primary analysis was retrospective and cohort-based, conducted in an acute inpatient rehabilitation setting. <br /><br />Key findings indicated:<br />1. A significantly higher risk of delirium was observed in patients with right-hemisphere stroke who also had spatial neglect compared to those without spatial neglect.<br />2. The incidence of 3D-CAM positive results was not statistically different between left and right hemisphere strokes.<br />3. Spatial neglect and delirium both significantly negatively impacted the functional independence of right-hemisphere stroke patients.<br /><br />The study revealed that the relative risk of delirium doubled in right-hemisphere stroke patients with spatial neglect. This suggests that spatial neglect is a key risk factor for developing delirium post-stroke. It emphasizes the importance of early detection and treatment of both conditions to improve functional outcomes.<br /><br />Furthermore, the study identified challenges in delirium assessment post-stroke due to overlaps with other cognitive deficits such as aphasia, particularly in left-brain stroke patients. Future research should aim to develop more accurate delirium screening methods that account for these confounders. The study underscores the need for targeted interventions to manage and mitigate the effects of delirium and spatial neglect in stroke rehabilitation contexts.<br /><br />In conclusion, stroke patients with right-hemisphere damage and spatial neglect are particularly vulnerable to delirium, necessitating comprehensive screening and tailored therapeutic approaches during the rehabilitation period.

Keywords

delirium

spatial neglect

right-hemisphere stroke

acute inpatient rehabilitation

cognitive functioning

unilateral spatial processing

3D-CAM

Catherine Bergego Scale

functional outcomes

stroke rehabilitation