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Erschienen in: InFo Neurologie + Psychiatrie 3/2022

22.03.2022 | Delir nicht substanzbedingt | Zertifizierte Fortbildung Neurologie

Akute Hirnfunktionsstörungen

Delir nach Schlaganfall

verfasst von: Dr. med. Annerose Mengel, Dr. med. Robert Fleischmann

Erschienen in: InFo Neurologie + Psychiatrie | Ausgabe 3/2022

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Das Schlaganfalldelir stellt einen der häufigsten modifizierbaren Risikofaktoren für einen verlängerten Krankenhausaufenthalt, erhöhte Mortalität und ein schlechteres funktionelles Outcome in der Akutphase des Schlaganfalls dar. In der neuesten Leitlinienversion für die Akuttherapie des ischämischen Schlaganfalls aus dem Mai 2021 wird das Schlaganfalldelir erstmals als bedeutende und häufige Komplikation nach einem Schlaganfall berücksichtigt [ 1]. Ebenfalls wird jedoch hervorgehoben, dass der Kenntnis- und Forschungsstand noch gering ist. Dieser Artikel gibt einen Überblick über die Evidenz für das klinische Management und zeigt Forschungsansätze für die Zukunft auf.
Literatur
1.
Zurück zum Zitat Ringleb P. S2e Leitlinie zurAkuttherapie des ischämischen SchlaganfallsAWMF-Registernummer 030-046Version 2021. https://​dgn.​org/​leitlinien/​ll-030-046-akuttherapie-des-ischaemischen-schlaganfalls-2021/​ Ringleb P. S2e Leitlinie zurAkuttherapie des ischämischen SchlaganfallsAWMF-Registernummer 030-046Version 2021. https://​dgn.​org/​leitlinien/​ll-030-046-akuttherapie-des-ischaemischen-schlaganfalls-2021/​
2.
Zurück zum Zitat Fleischmann R, Warwas S, Andrasch T, Kunz R, Witt C, Mengel A, et al. Course and Recognition of Poststroke Delirium: A Prospective Noninferiority Trial of Delirium Screening Tools. Stroke 2021;52(2):471-8 Fleischmann R, Warwas S, Andrasch T, Kunz R, Witt C, Mengel A, et al. Course and Recognition of Poststroke Delirium: A Prospective Noninferiority Trial of Delirium Screening Tools. Stroke 2021;52(2):471-8
3.
Zurück zum Zitat Shi Q, Presutti R, Selchen D, Saposnik G. Delirium in acute stroke: a systematic review and meta-analysis. Stroke 2012;43(3):645-9 Shi Q, Presutti R, Selchen D, Saposnik G. Delirium in acute stroke: a systematic review and meta-analysis. Stroke 2012;43(3):645-9
4.
Zurück zum Zitat Jackson JC, Pandharipande PP, Girard TD, Brummel NE, Thompson JL, Hughes CG, et al. Depression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU study: a longitudinal cohort study. Lancet Respir Med 2014;2(5):369-79 Jackson JC, Pandharipande PP, Girard TD, Brummel NE, Thompson JL, Hughes CG, et al. Depression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU study: a longitudinal cohort study. Lancet Respir Med 2014;2(5):369-79
5.
Zurück zum Zitat Chan EKW, Shen Q, Cordato D, Kneebone I, Xu YH, Chan DKY. Delirium post-stroke: short- to long-term effect on anxiety and depression compared to effect on cognition. Top Stroke Rehabil 2017;24(8):597-600 Chan EKW, Shen Q, Cordato D, Kneebone I, Xu YH, Chan DKY. Delirium post-stroke: short- to long-term effect on anxiety and depression compared to effect on cognition. Top Stroke Rehabil 2017;24(8):597-600
6.
Zurück zum Zitat Qu J, Chen Y, Luo G, Zhong H, Xiao W, Yin H. Delirium in the Acute Phase of Ischemic Stroke: Incidence, Risk Factors, and Effects on Functional Outcome. J Stroke Cerebrovasc Dis 2018 Oct;27(10):2641-7 Qu J, Chen Y, Luo G, Zhong H, Xiao W, Yin H. Delirium in the Acute Phase of Ischemic Stroke: Incidence, Risk Factors, and Effects on Functional Outcome. J Stroke Cerebrovasc Dis 2018 Oct;27(10):2641-7
7.
Zurück zum Zitat Turco R, Bellelli G, Morandi A, Gentile S, Trabucchi M. The effect of poststroke delirium on short-term outcomes of elderly patients undergoing rehabilitation. Journal of geriatric psychiatry and neurology 2013;26(2):63-8 Turco R, Bellelli G, Morandi A, Gentile S, Trabucchi M. The effect of poststroke delirium on short-term outcomes of elderly patients undergoing rehabilitation. Journal of geriatric psychiatry and neurology 2013;26(2):63-8
8.
Zurück zum Zitat Pandharipande PP, Girard TD, Jackson JC, Morandi A, Thompson JL, Pun BT, et al. Long-term cognitive impairment after critical illness. The New England journal of medicine 2013;369(14):1306-16 Pandharipande PP, Girard TD, Jackson JC, Morandi A, Thompson JL, Pun BT, et al. Long-term cognitive impairment after critical illness. The New England journal of medicine 2013;369(14):1306-16
9.
Zurück zum Zitat Oldenbeuving AW, de Kort PL, Jansen BP, Algra A, Kappelle LJ, Roks G. Delirium in the acute phase after stroke: incidence, risk factors, and outcome. Neurology 2011;76(11):993-9 Oldenbeuving AW, de Kort PL, Jansen BP, Algra A, Kappelle LJ, Roks G. Delirium in the acute phase after stroke: incidence, risk factors, and outcome. Neurology 2011;76(11):993-9
10.
Zurück zum Zitat Maldonado JR. Delirium pathophysiology: An updated hypothesis of the etiology of acute brain failure. International journal of geriatric psychiatry 2018;33(11):1428-57 Maldonado JR. Delirium pathophysiology: An updated hypothesis of the etiology of acute brain failure. International journal of geriatric psychiatry 2018;33(11):1428-57
11.
Zurück zum Zitat Aranake-Chrisinger A, Avidan MS. Postoperative delirium portends descent to dementia. British journal of anaesthesia 2017;119(2):285-8 Aranake-Chrisinger A, Avidan MS. Postoperative delirium portends descent to dementia. British journal of anaesthesia 2017;119(2):285-8
12.
Zurück zum Zitat American Psychiatric Association. Diagnostic and statistical manual of mental disorders, (DSM-5®): American Psychiatric Pub; 2013. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, (DSM-5®): American Psychiatric Pub; 2013.
13.
Zurück zum Zitat Falkai, P., & American Psychiatric Association. 2015. Diagnostisches und statistisches Manual psychischer Störungen : DSM-5® (5. Fassung ed.). Göttingen: Hogrefe Falkai, P., & American Psychiatric Association. 2015. Diagnostisches und statistisches Manual psychischer Störungen : DSM-5® (5. Fassung ed.). Göttingen: Hogrefe
14.
Zurück zum Zitat Radtke FM, Franck M et al. Die Intensive Care Delirium Screening Checklist (ICDSC). Anästhesiol Intensivmed Notfallmed Schmerzther 2009;2:80-86 Radtke FM, Franck M et al. Die Intensive Care Delirium Screening Checklist (ICDSC). Anästhesiol Intensivmed Notfallmed Schmerzther 2009;2:80-86
15.
Zurück zum Zitat Günther U, Wrigge H et al. German short version of the Confusion Assessment Method for routine delirium monitoring. Anästh Intensivmed 2009;50:592-600 Günther U, Wrigge H et al. German short version of the Confusion Assessment Method for routine delirium monitoring. Anästh Intensivmed 2009;50:592-600
16.
Zurück zum Zitat De J, Wand AP. Delirium Screening: A Systematic Review of Delirium Screening Tools in Hospitalized Patients. The Gerontologist 2015;55(6):1079-99 De J, Wand AP. Delirium Screening: A Systematic Review of Delirium Screening Tools in Hospitalized Patients. The Gerontologist 2015;55(6):1079-99
17.
Zurück zum Zitat Serpa Neto A, Slooter AJ. Delirium detection in stroke patients. Critical care medicine 2012;40(7):2266-7; author reply 7-8 Serpa Neto A, Slooter AJ. Delirium detection in stroke patients. Critical care medicine 2012;40(7):2266-7; author reply 7-8
18.
Zurück zum Zitat Patel MB, Bednarik J, Lee P, Shehabi Y, Salluh JI, Slooter AJ, et al. Delirium Monitoring in Neurocritically Ill Patients: A Systematic Review. Critical care medicine 2018;46(11):1832-41 Patel MB, Bednarik J, Lee P, Shehabi Y, Salluh JI, Slooter AJ, et al. Delirium Monitoring in Neurocritically Ill Patients: A Systematic Review. Critical care medicine 2018;46(11):1832-41
19.
Zurück zum Zitat Berthier ML. Poststroke aphasia : epidemiology, pathophysiology and treatment. Drugs Aging 2005;22(2):163-82 Berthier ML. Poststroke aphasia : epidemiology, pathophysiology and treatment. Drugs Aging 2005;22(2):163-82
20.
Zurück zum Zitat Bosselmann C, Zurloh J, Stefanou MI, Stadler V, Weber Y, Lerche H, et al. Delirium Screening in Aphasic Patients With the Intensive Care Delirium Screening Checklist (ICDSC): A Prospective Cohort Study. Front Neurol 2019;10:1198 Bosselmann C, Zurloh J, Stefanou MI, Stadler V, Weber Y, Lerche H, et al. Delirium Screening in Aphasic Patients With the Intensive Care Delirium Screening Checklist (ICDSC): A Prospective Cohort Study. Front Neurol 2019;10:1198
21.
Zurück zum Zitat FDA-NIH Biomarker Working Group. BEST (Biomarkers, EndpointS, and other Tools) Resource. Food and Drug Administration (US) 2016. FDA-NIH Biomarker Working Group. BEST (Biomarkers, EndpointS, and other Tools) Resource. Food and Drug Administration (US) 2016.
22.
Zurück zum Zitat Mahanna-Gabrielli E, Schenning KJ, Eriksson LI, Browndyke JN, Wright CB, Culley DJ, et al. State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018. British journal of anaesthesia 2019;123(4):464-78 Mahanna-Gabrielli E, Schenning KJ, Eriksson LI, Browndyke JN, Wright CB, Culley DJ, et al. State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018. British journal of anaesthesia 2019;123(4):464-78
23.
Zurück zum Zitat Nitchingham A, Kumar V, Shenkin S, Ferguson KJ, Caplan GA. A systematic review of neuroimaging in delirium: predictors, correlates and consequences. International journal of geriatric psychiatry 2018;33(11):1458-78 Nitchingham A, Kumar V, Shenkin S, Ferguson KJ, Caplan GA. A systematic review of neuroimaging in delirium: predictors, correlates and consequences. International journal of geriatric psychiatry 2018;33(11):1458-78
24.
Zurück zum Zitat Hufschmidt A, Shabarin V. Diagnostic yield of cerebral imaging in patients with acute confusion. Acta neurologica Scandinavica 2008;118(4):245-50 Hufschmidt A, Shabarin V. Diagnostic yield of cerebral imaging in patients with acute confusion. Acta neurologica Scandinavica 2008;118(4):245-50
25.
Zurück zum Zitat van Montfort SJT, van Dellen E, van den Bosch AMR, Otte WM, Schutte MJL, Choi SH et al. Resting-state fMRI reveals network disintegration during delirium NeuroImage Clinical 2018;20:35-41 van Montfort SJT, van Dellen E, van den Bosch AMR, Otte WM, Schutte MJL, Choi SH et al. Resting-state fMRI reveals network disintegration during delirium NeuroImage Clinical 2018;20:35-41
26.
Zurück zum Zitat Naeije G, Depondt C, Meeus C, Korpak K, Pepersack T, Legros B. EEG patterns compatible with nonconvulsive status epilepticus are common in elderly patients with delirium: a prospective study with continuous EEG monitoring. Epilepsy Behav 2014;36:18-21 Naeije G, Depondt C, Meeus C, Korpak K, Pepersack T, Legros B. EEG patterns compatible with nonconvulsive status epilepticus are common in elderly patients with delirium: a prospective study with continuous EEG monitoring. Epilepsy Behav 2014;36:18-21
27.
Zurück zum Zitat Baron R, Binder A, Biniek R, Braune S, Buerkle H, Dall P, et al. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) - short version. Ger Med Sci 2015;13:Doc19 Baron R, Binder A, Biniek R, Braune S, Buerkle H, Dall P, et al. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) - short version. Ger Med Sci 2015;13:Doc19
28.
Zurück zum Zitat Kimchi EY, Neelagiri A, Whitt W, Sagi AR, Ryan SL, Gadbois G, et al. Clinical EEG slowing correlates with delirium severity and predicts poor clinical outcomes. Neurology 2019;93(13):e1260-e71 Kimchi EY, Neelagiri A, Whitt W, Sagi AR, Ryan SL, Gadbois G, et al. Clinical EEG slowing correlates with delirium severity and predicts poor clinical outcomes. Neurology 2019;93(13):e1260-e71
29.
Zurück zum Zitat Fleischmann R, Trankner S, Bathe-Peters R, Ronnefarth M, Schmidt S, Schreiber SJ, et al. Diagnostic Performance and Utility of Quantitative EEG Analyses in Delirium: Confirmatory Results From a Large Retrospective Case-Control Study. Clinical EEG and neuroscience 2018:1550059418767584 Fleischmann R, Trankner S, Bathe-Peters R, Ronnefarth M, Schmidt S, Schreiber SJ, et al. Diagnostic Performance and Utility of Quantitative EEG Analyses in Delirium: Confirmatory Results From a Large Retrospective Case-Control Study. Clinical EEG and neuroscience 2018:1550059418767584
30.
Zurück zum Zitat van der Kooi AW, Zaal IJ, Klijn FA, Koek HL, Meijer RC, Leijten FS, et al. Delirium detection using EEG: what and how to measure. Chest 2015;147(1):94-101 van der Kooi AW, Zaal IJ, Klijn FA, Koek HL, Meijer RC, Leijten FS, et al. Delirium detection using EEG: what and how to measure. Chest 2015;147(1):94-101
31.
Zurück zum Zitat Shafi MM, Santarnecchi E, Fong TG, Jones RN, Marcantonio ER, Pascual-Leone A, et al. Advancing the Neurophysiological Understanding of Delirium. J Am Geriatr Soc 2017 Jun;65(6):1114-8 Shafi MM, Santarnecchi E, Fong TG, Jones RN, Marcantonio ER, Pascual-Leone A, et al. Advancing the Neurophysiological Understanding of Delirium. J Am Geriatr Soc 2017 Jun;65(6):1114-8
32.
Zurück zum Zitat Stephan KE, Iglesias S, Heinzle J, Diaconescu AO. Translational Perspectives for Computational Neuroimaging. Neuron 2015;87(4):716-32 Stephan KE, Iglesias S, Heinzle J, Diaconescu AO. Translational Perspectives for Computational Neuroimaging. Neuron 2015;87(4):716-32
33.
Zurück zum Zitat Bai Y, Xia X, Kang J, Yin X, Yang Y, He J, et al. Evaluating the Effect of Repetitive Transcranial Magnetic Stimulation on Disorders of Consciousness by Using TMS-EEG. Front Neurosci 2016;10:473 Bai Y, Xia X, Kang J, Yin X, Yang Y, He J, et al. Evaluating the Effect of Repetitive Transcranial Magnetic Stimulation on Disorders of Consciousness by Using TMS-EEG. Front Neurosci 2016;10:473
34.
Zurück zum Zitat Girard TD, Exline MC, Carson SS, Hough CL, Rock P, Gong MN, et al. Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness. N Engl J Med 2018;379(26):2506-16 Girard TD, Exline MC, Carson SS, Hough CL, Rock P, Gong MN, et al. Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness. N Engl J Med 2018;379(26):2506-16
35.
Zurück zum Zitat Nishikimi M, Numaguchi A, Takahashi K, Miyagawa Y, Matsui K, Higashi M, et al. Effect of Administration of Ramelteon, a Melatonin Receptor Agonist, on the Duration of Stay in the ICU: A Single-Center Randomized Placebo-Controlled Trial. Crit Care Med 2018;46(7):1099-105 Nishikimi M, Numaguchi A, Takahashi K, Miyagawa Y, Matsui K, Higashi M, et al. Effect of Administration of Ramelteon, a Melatonin Receptor Agonist, on the Duration of Stay in the ICU: A Single-Center Randomized Placebo-Controlled Trial. Crit Care Med 2018;46(7):1099-105
36.
Zurück zum Zitat Mengel A, Zurloh J, Bosselmann C, Brendel B, Stadler V, Sartor-Pfeiffer J et al. Delirium REduction after administration of melatonin in acute ischemic stroke (DREAMS): A propensity score-matched analysis. European journal of neurology 2021;28(6):1958-66 Mengel A, Zurloh J, Bosselmann C, Brendel B, Stadler V, Sartor-Pfeiffer J et al. Delirium REduction after administration of melatonin in acute ischemic stroke (DREAMS): A propensity score-matched analysis. European journal of neurology 2021;28(6):1958-66
37.
Zurück zum Zitat MaschkeM et al. S1 Leitlienie: Delir und Verwirrtheits-zustände inklusive Alkoholentzugsdelir. Leitlinien für Diagnostik und Therapie in der Neurologie. 2020. https://​dgn.​org/​leitlinien/​ll-030-006-delir-und-verwirrtheitszus​taende-inklusive-alkoholentzugsde​lir/​ MaschkeM et al. S1 Leitlienie: Delir und Verwirrtheits-zustände inklusive Alkoholentzugsdelir. Leitlinien für Diagnostik und Therapie in der Neurologie. 2020. https://​dgn.​org/​leitlinien/​ll-030-006-delir-und-verwirrtheitszus​taende-inklusive-alkoholentzugsde​lir/​
38.
Zurück zum Zitat Burry L, Hutton B, Williamson DR, Mehta S, Adhikari NK, Cheng W, et al. Pharmacological interventions for the treatment of delirium in critically ill adults. Cochrane Database Syst Rev 2019;9:CD011749 Burry L, Hutton B, Williamson DR, Mehta S, Adhikari NK, Cheng W, et al. Pharmacological interventions for the treatment of delirium in critically ill adults. Cochrane Database Syst Rev 2019;9:CD011749
Metadaten
Titel
Akute Hirnfunktionsstörungen
Delir nach Schlaganfall
verfasst von
Dr. med. Annerose Mengel
Dr. med. Robert Fleischmann
Publikationsdatum
22.03.2022