Cognitive Trajectories of Post-Stroke Delirium: Longitudinal Global and Domain-Specific Impairment and Digital Markers
Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Background
Poststroke cognitive impairment (PSCI) and poststroke delirium (PSD) remain underexplored. Longitudinal assessments of cognition before PSD onset and at follow-up are scarce, leaving the association between PSD and subsequent global and domain-specific PSCI unclear. Digital assessments using task-derived kinematic parameters may provide complementary insights into cognitive vulnerability and PSD risk.
Methods
In this prospective longitudinal study, patients with acute stroke underwent multidomain tablet-based neuropsychological assessment within the acute phase, before PSD onset, and at 90 days post-stroke. Global PSCI (gPSCI) and domain-specific PSCI (attention and processing speed, executive functions, verbal memory, language, and visuospatial-construction) were assessed using norm-referenced cognitive performance. Cognitive outcomes were compared between patients with and without PSD at both time points. Functional outcome, mortality, and quality of life were assessed at 90 days. Exploratory random forest analyses evaluated the discriminatory ability of acute-phase task-derived kinematic parameters.
Results
Among 31 patients with stroke, 10 developed PSD, 18 served as controls, and 3 dropped out. At 90 days, patients with PSD had more severe gPSCI than controls ( U =19.500, p <0.001), whereas the acute-phase difference was not significant (U=50.500, p =0.057). Domain-specific analyses revealed distinct temporal patterns of cognitive impairment. During the acute phase, patients with subsequent PSD, showed significantly more severe impairments in attention and processing speed (U=29.500; p =0.003) and visuospatial-construction (U=31.500; p =0.004). At 90 days, differences in attention and processing speed persisted ( U =21.000, p <0.001) with additional significant differences in executive functions ( U =38.500, p =0.012) and language ( U =45.500, p =0.031). Kinematic parameters showed discriminatory performance comparable to gPSCI (78.89% versus 81.50%). At 90 days, PSD was also associated with worse functional outcome (U=31.500, p =0.004), higher mortality ( p =0.037), and lower mental quality of life ( p =0.021).
Conclusions
PSD is associated with more severe global PSCI at 90 days post-stroke and distinct temporal pattern of domain-specific PSCI. Task-derived kinematic parameters may complement conventional cognitive scores. Larger multicenter studies are needed to validate these findings.
Trial Registration
ClinicalTrials.gov: NCT06680336 . https://clinicaltrials.gov/study/NCT06680336
