Introduction

Post-stroke delirium (PSD) is a common yet underrecognized complication following stroke, with its effect on stroke rehabilitation being the subject of limited attention. The objective of this narrative review is to provide an overview of core issues in PSD including epidemiology, diagnostic challenges, and management considerations, with an emphasis on the rehabilitation phase.

Methods

Ovid Medline and Google Scholar were searched through February 2023 using keywords related to delirium, rehabilitation, and the post-stroke period. Only studies conducted on adults (≥18 years) and written in the English language were included.

Results

PSD affects approximately 25% of stroke patients, and often persists well into the post-acute phase, with a negative impact on rehabilitation outcomes including lengths of stay, function, and cognition. Certain stroke and patient characteristics can help predict risk for PSD. The diagnosis of delirium becomes more challenging when superimposed on stroke deficits (such as attentional impairment or other cognitive, psychiatric, or behavioural disorders), leading to underdiagnosis, overdiagnosis, or misdiagnosis. Particularly in patients with post-stroke language or cognitive disorders, common screening tools are less accurate. The multidisciplinary rehabilitation team should be involved in management of PSD as rehabilitative activities can be beneficial for patients who can participate safely. Addressing barriers to effective delirium care at various levels of the health care system can improve rehabilitation trajectories for these patients.

Conclusions

PSD is a disease entity commonly encountered in the rehabilitation setting, but it is challenging to diagnose and manage. New delirium screening tools and management approaches specific for the post-stroke and rehabilitation settings are needed.

中文翻译：

---

中风后谵妄和康复环境的挑战：叙述性回顾

介绍

中风后谵妄（PSD）是中风后一种常见但未被充分认识的并发症，其对中风康复的影响受到的关注有限。本叙述性综述的目的是概述 PSD 的核心问题，包括流行病学、诊断挑战和管理考虑因素，重点是康复阶段。

方法

截至 2023 年 2 月，使用与谵妄、康复和中风后时期相关的关键词对 Ovid Medline 和 Google Scholar 进行了搜索。仅纳入对成人（≥18 岁）进行且以英语撰写的研究。

结果

PSD 影响大约 25% 的中风患者，并且通常持续到急性后阶段，对康复结果（包括住院时间、功能和认知）产生负面影响。某些中风和患者特征可以帮助预测 PSD 风险。当与中风缺陷（例如注意力障碍或其他认知、精神或行为障碍）叠加时，谵妄的诊断变得更具挑战性，导致诊断不足、过度诊断或误诊。特别是对于患有中风后语言或认知障碍的患者，常见的筛查工具不太准确。多学科康复团队应参与 PSD 的管理，因为康复活动对能够安全参与的患者有益。解决医疗保健系统各级有效谵妄护理的障碍可以改善这些患者的康复轨迹。

结论

PSD 是康复机构中常见的一种疾病，但诊断和治疗具有挑战性。需要针对中风后和康复环境的新的谵妄筛查工具和管理方法。