The Prevalence of Post Stroke Delirium and associated risk factors a multicenter prospective study in hospitalized patients at Tikur Anbessa Specialized Hospital, Yekatit 12 Hospital Medical College and Yehulshet Specialty Clinic, Addis Ababa, Ethiopia.

The Prevalence of Post Stroke Delirium and associated risk factors a multicenter prospective study in hospitalized patients at Tikur Anbessa Specialized Hospital, Yekatit 12 Hospital Medical College and Yehulshet Specialty Clinic, Addis Ababa, Ethiopia. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Prevalence of Post Stroke Delirium and associated risk factors a multicenter prospective study in hospitalized patients at Tikur Anbessa Specialized Hospital, Yekatit 12 Hospital Medical College and Yehulshet Specialty Clinic, Addis Ababa, Ethiopia. Beruk Ketema, Getahun Mengistu, Dereje Melka, Yared Zenebe, Mehila Zebenigus, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4380767/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 Mar, 2025 Read the published version in BMC Neurology → Version 1 posted 10 You are reading this latest preprint version Abstract Background Post-stroke delirium, a frequent and significant complication of stroke, manifests as a sudden onset of confusion, altered consciousness, and cognitive decline. Various factors contribute to its occurrence, including old age, multiple comorbidity, electrolyte abnormalities, and infections. The impact of post-stroke delirium on stroke recovery is substantial. It leads to prolonged hospital stays, heightened risk of institutionalization, increased dependence, and elevated mortality rates. As a result, early identification and prompt treatment of post-stroke delirium are imperative for optimizing outcomes in stroke patients. Objective The objective of this study is to determine the Prevalence of post-stroke delirium and associated risk factors in hospitalized patients at TASH, Y12HMC, and YSC, Addis Ababa, Ethiopia from August to December 2023 G.c. Method We performed a prospective observational cross-sectional study, including all the stroke patients admitted to the respective study areas during the study period from August to December 2023 G.c. Delirium Stroke Tikur Anbessa Specialized Hospital Yekatit 12 Hospital and Medical College Yehulshet Specialty Clinic Figures Figure 1 1. Introduction Background Delirium and Confusional States These conditions frequently manifest in patients with medical illnesses, particularly among the elderly. [ 1 , 2 ] Delirium is a sudden alteration in mental state marked by irregular and varying levels of attention. It involves a disruption in consciousness levels and a decreased capacity to concentrate, guide, change, and maintain attention. [ 6 ] Consciousness requires both arousal and attentiveness; if one is conscious of something . The brainstem and diencephalon's reticular activating system mediates arousal. Attentiveness depends on the cerebral cortex, especially polymodal association areas. [ 3 ] Delirium (also known as acute Confusional state) is an organically caused decline from a previous baseline of mental function that develops over a short period, typically hours to days. A variety of terms are used to describe delirium, including acute brain failure, encephalopathy, acute Confusional state, and postoperative or intensive care unit (ICU) psychosis. [ 15 ] In the DSM-5, the American Psychiatric Association identifies five essential characteristics that define delirium: 1. Attention Disturbance : Reduced ability to direct, focus, sustain, and shift attention, coupled with impaired awareness. 2. Rapid Onset : Develops over a short period (usually hours to days), differs from baseline, and fluctuates throughout the day. 3. Cognitive Impairment : Additional deficits in memory, orientation, language, visuospatial abilities, or perception. 4. Exclusion Criteria : Not attributable to another neurocognitive disorder, and not occurring during severe arousal reduction (e.g., coma). 5. Etiological Evidence : Supported by history, physical examination, or lab findings related to medical conditions, substance use, or medication side effects. Furthermore, delirium may exhibit psychomotor disturbances (hypoactivity, hyperactivity) and variable emotional states (fear, depression, euphoria, perplexity). The biological basis of delirium and confusion is not well understood in part because it is difficult to study severely ill patients, but humoral and Neurotransmitter mechanisms have been hypothesized. Delirium is a multifactorial disorder. Factors that increase the risk for delirium and Confusional states can be classified into those that increase baseline vulnerability and those that precipitate the disturbance. [ 3 , 4 ] The most commonly identified risk factors are underlying brain diseases such as stroke, dementia, or Parkinson's disease; these are present in nearly one-half of older patients with delirium. Numerous and diverse factors can cause delirium; some prominent ones are infection, dehydration, immobility (including the use of restraints), malnutrition, Polypharmacy (especially psychoactive medicines), and the use of bladder catheters. There are multiple Drugs believed to cause or prolong delirium or Confusional states like Anticholinergic, Analgesics, and other varied Medications. [ 3 , 4 ] Delirium develops over hours to days and typically persists for days and even months. The most useful characteristic for distinguishing delirium from dementia is the acuteness of the presentation. In addition, the features of delirium are not stable, typically becoming worse in the evening and at night. It is not unusual for a patient with delirium to appear relatively lucid during morning rounds. [ 4 ] As mentioned previously, clinicians often fail to recognize delirium; in some reports, this happens in more than 70% of cases. Behavioral problems or cognitive impairment may be readily apparent but wrongly attributed to the patient's age, dementia, or other mental disorders. [ 5 ] 2. Methods Study Area and Period Study Area 1. Tikur Anbessa Specialized Hospital: Being a multifunctional tertiary care university-affiliated hospital, Tikur Anbessa serves as a pivotal location for conducting the study. The presence of a dedicated Stroke unit, complete with an organized team consisting of senior neurologists, residents, and trained nurses, illustrates a substantial infrastructure for stroke patient care. The existence of a comprehensive protocol and treatment guidelines further reinforces the hospital's commitment to stroke management. The average number of stroke patients per month at TASH is 16. 2. Yekatit 12 Hospital Medical College: As another prominent hospital in the capital city, Yekatit 12 Medical College Hospital provides additional resources and networks for the study. The availability of key departments, including Emergency, ward, and Outpatient services, broadens the scope for potential collaboration and patient recruitment. 3. Yehulshet Specialty Clinic: with its specialty in neurological and internal medicine, offers a unique setting that complements the capabilities of the hospitals. The clinic's focus on neurological specialties and wide range of medical services adds diversity and depth to the study's potential participant pool. In addition to the individual strengths of each location, the collective impact of incorporating diverse clinical settings into the study has the potential to yield comprehensive insights into the prevalence of delirium in stroke patients and associated risk factors. The robust setup of the stroke unit at TASH, combined with the broader medical services at both hospital locations and the focused expertise of YSC, presents a network of resources and knowledge that can enhance the study's outcomes. The inclusion of multiple institutions within the study not only broadens the geographical reach but also contributes to the diversification of patient demographics and treatment approaches, enriching the data and findings. Given the extensive facilities, specialized care, and collective expertise available within these settings, the study promises to be well-positioned for success. Study Period The Study will be conducted at Tikur Anbessa Specialized Hospital, Yekatit 12 Medical College Hospital, and Yehulshet Specialty Clinic in Addis Ababa, Ethiopia from August 1, 2023 to December 31, 2023. Study Design A 5-month Observational prospective Cohort study from August 1 2023 G.C to December 31 2023 G.C. Source Population All Acute Stroke Patients Admitted to the Ward, ER, and Stroke Unit at TASH, Y12HMC, and YSC. Sampled population Patients Admitted during the study period were considered as sample Population. Inclusion Criteria Present ischemic or hemorrhagic stroke including TIA, and patients with cerebral venous thrombosis. Exclusion Criteria 1. Absence of consent for research by the patients themselves or legal representatives; 2. Patients with initial stroke-like symptoms that could not be confirmed as stroke. 3. Patients who have underlying Cognitive disorders like Dementia 4. Patient with an unstable medical condition requiring immediate medical or surgical management 5. Patients with Richmond Agitation Sedation Scale (RASS) score − 3 to -5 and patients who are unable to be assessed for delirium. 6. Acute Stroke Patients with Wernicke's Aphasia. Sample Size and Sampling Technique The actual sample size was determined by using the single population proportion formula, where the following assumptions were considered: 95% confidence interval and 5% margin of error. All patients admitted to the stroke unit during the period of data collection were selected to be included in the study. To determine sample size a p-value of 50% was taken since there was no previous study conducted in our country, 10% non-responder rate was added to the calculated sample size. The sample size was deducted by the finite population correction formula because our source of population was less than 10,000 patients. Making the final sample size 101. During the Data collection Amendment was requested from the Department to add a sampling population since the sample size was not being made from the stroke unit alone. All Patients admitted to the stroke unit, ward at TASH, Y12HMC, and YSC in the study period were included in the study if they didn’t have one of the Exclusion criteria, RAAS was used to assess the arousability of the patient and to check the premorbid cognitive disturbances respectively, we used the RAAS score of 1 to 4 to define hyperactive delirium and Hypoactive delirium of 0 to -3, patients were assessed for delirium using the well-validated CAM tool as soon as they are admitted to the stroke unit and they were screened for any of the Risk factors that are listed and they were followed in the stroke unit and were be screened every 8–12 hours until they are discharged and transferred to another inpatient setting, Additionally, the total duration of admission and the Outcome of each patient was followed. Data Collection Instrument, Procedure and Method Data was collected using an interviewer-administered questionnaire which was adapted from previously published studies with some modifications to ensure applicability to our current study, after it was checked for validity and reliability after pretesting. The questionnaire consists of questions on sociodemographic factors, medical history, and history of drug intake, substance use, pain control, environmental stressors, and more. Study Variables Independent • Age, Gender, Education, Address, Diagnosis at admission, Comorbidities, Nutritional Status, Type of Stroke and Severity, Administered Medication during hospitalization, The presence of psychiatric disorders or Dementia before admission, Hearing and visual impairment, History of Alcohol abuse, Immobilization, Use of Physical restraints, Environmental conditions, History of catheterization and Urinary Retention, Constipation, Surgical Procedures, Electrolyte Imbalance Polypharmacy, Poor pain control, Sleep Deprivation, and Place of admission. Dependent • Prevalence of delirium in stroke unit patients of Tikur Anbessa. Operational Definitions • Constipation - Fewer than three bowel movements (BMs) per week. • Polypharmacy – The Concurrent use of 5 or more medications • Sleep Deprivation – defined as less than 6 hours of sleep per night • Alcohol abuse is defined as > 21 units per week for males and 15 units per week for females. • Stroke of Undetermined Etiology – 2 more potential causes of stroke were identified, but no identified etiology was identified despite extensive investigation or incomplete diagnostic evaluation. Data quality control • The Investigator has examined the appropriateness of the methodologies followed. The questionnaire was reviewed for completeness and pre-testing was done. The questionnaires were pre-tested on 5% of the sample in a similar setting, which was not part of the study. Filled questionnaires were checked for completeness and consistency of information and once weekly during data collection by the investigator. The template was checked for internal consistency and any inconsistency or ambiguity was addressed in time. The authors confirm that the data supporting the findings of this study are available within its supplementary materials. Ethical clearance All information collected was used solely for the intended purpose. Personal Identifier Information (PII), including names of patients, was not included in the questionnaire. Codes were used instead and completed questionnaires were stored safely by the Investigator. Data from the research is Available with the Primary investigator for purposes of Publication or additional Scrutiny. • Proposal approval was obtained before the beginning of data collection from Addis Ababa University College of Health Science IRB and Research and Publication Committee (RPC) of the Department of Neurology, College Health Sciences (CHS) TASH. • Additionally Ethical clearance was approved by Ethics committee of Tikur Anbessa Specialized Hospital. This research received no specific grant from any funding agency in the public, commercial, or nonprofit sectors. All authors declare that they have no conflicts of interest. • Consent was asked from all participating individuals and only those who consented were included in the study. 3. Result Socio-demography A total of 101 patients were included in the study. The majority of the study subjects' age is greater than 60, with the mean (SD) age of the study participants being 56.05 ± 15.38 years, with the youngest patient being 22 and the oldest patient being 88 years. 40.6% of the cases were from TASH, 31.7% were from Y12HMC and 27.7% were from YSC. The majority of Patients 87.1% were from Addis Ababa and 12.9% of the participants were from Different regions of Ethiopia like Oromia, Amhara, and SNNPR. The majority 56 (55.4%) of the patients were females. The majority of the participants 76.2% were Orthodox Christians. 80.2% were married and 41.6% had Primary School as their Level of education. Table 1 Socio-demographic and behavioral characteristics of the study participants at TASH, Y12HMC, and YSC from August 1-December 31, 2023 G.c. Frequency Age 18–34 11.9% 35–59 41.6% ≥ 60 46.5% Gender Male 44.6% Female 55.4% Educational Status Unable to Read and Write 9.9% Primary School 41.6% Secondary School 23.8% Diploma and Above 24.8% Marital Status Married 80.2% Single 10.9% Divorced 4.0% Widowed 5.0% Religion Christian 76.2% Muslim 16.8% Other 6.9% Medical comorbidities From a total of 101 patients, 63.4% of them have Hypertension, 20.8% of them have Diabetes and around 30.7% of them have Cardiac comorbidity which is predominantly chronic rheumatic valvular heart disease. 4% of them had a history of known malignancy and 18.8% of them Developed Sepsis through their stay in the Hospital. And when we see their History of substance use 9.9% of the participants have recent Alcohol abuse, 4% of them smoked Cigarettes and 5.9% chewed Khat. The Data also showed that Polypharmacy is as high as 31.7% and there was Benzodiazepine use in 5% of the Participants because they developed a complication of seizure during their stay at the Hospital. And 15% of the Participants have Developed Electrolyte Derangement like Hypernatremia and Hypernatremia. Table 2 Substance use and iatrogenic risk factors for the development of Post post-stroke delirium in study participants at TASH, Y12HMC, and YSC from August 1-December 31, 2023 G.c. Frequency Alcohol Abuse Recent Use of Alcohol 9.9% No Use of Alcohol 90.1% Current Smoker Smoker 4.0% Non-Smoker 96.0% History of chewing chat Chews Khat 5.9% Non Khat Chewer 94.1% Presence of Polypharmacy Polypharmacy Present 21.8% No Polypharmacy 78.2% Presence of Visual impairment Has Visual Impairment 5.9% No Visual Impairment 94.1% Benzodiazepine use Use of Benzodiazepine 5.0% No Benzodiazepine Use 95.0% Did the patient have any Electrolyte derangements? Have Electrolyte Derangement 15.0% No Electrolyte Derangement 85.0% Type of Stroke When we see the type of stroke 66.3% of them developed Acute ischemic stroke 26.7% of them had Hemorrhagic stroke and the remaining 6.9% of them developed CVT, And from the Acute ischemic strokes 47.8% of the participants had large artery stroke, 34.3% Cardio embolic stroke, 10.4% small vessel occlusion, 1.5% had stroke of other determined Etiology and 6% had stroke of undetermined etiology and when we see the laterality of the stroke majority of them 53.5% had Right sided Stroke, 41.6% of them were Left-Sided and 5% had no laterality. Table 3 Stroke Subtypes and Laterality of Stroke of the study participants at TASH, Y12HMC, and YSC from August 1-December 31, 2023 G.c. Frequency Stroke Type Acute Ischemic Stroke 66.3% Acute Hemorrhagic Stroke 26.7% CVT 6.9% Subtype of Ischemic stroke(TOAST) Large Artery Stroke 47.8% Cardio-embolic Stroke 34.3% Small Vessel Occlusion 10.4% Stroke of other Determined Etiology 1.5% Stroke of Undetermined Etiology 6.0% Laterality of Stroke Right Hemisphere 53.5% Left Hemisphere 41.6% No Laterality 5.0% Table 4 Stroke Subtypes and Laterality of Stroke and Development of Delirium. Stroke Subtypes and laterality of Stroke with Development of Delirium Frequency of Delirium Stroke Type Acute Ischemic Stroke 69.2% Acute Hemorrhagic Stroke 30.8% CVT 0.0% Subtype of Ischemic stroke(TOAST) Large Artery Stroke 55.6% Cardio-embolic Stroke 27.8% Small Vessel Occlusion 16.7% Stroke of other Determined Etiology 0.0% Stroke of Undetermined Etiology 0.0% Laterality of Stroke Right Hemisphere 50.0% Left Hemisphere 46.2% No Laterality 3.8% Prevalence of Post Stroke Delirium and Associated Risk factors Out of 101 patients, 26(25.7%) had Post-stroke Delirium, Age, Gender, Type of stroke, history of hypertension, history of Diabetes, history of Cardiac illness, history of alcohol abuse, smoking cigarette and chewing khat, Presence of Polypharmacy, presence of sepsis, presence of electrolyte imbalance, sleep deprivation, Benzodiazepine use, constipation were individually assessed with Bivariate analysis and those statistically significant were further put into multivariate logistic regression. Upon Multivariate Logistic Regression Age Greater than 60(AOR = 19.1, 95% CI (1.7–211) p = 0.016, Presence of Sepsis (AOR = 8.3, 95% CI (1.2–56) P = 0.029, Presence of Polypharmacy (AOR = 157, 95% CI (10.2–244) P = 0.0001, Presence of Electrolyte Derangement (AOR = 65.2, 95% CI (3.4-124.1) P = 0.005 were statistically significant. Table 5 Multivariate Logistic regression analysis between the development of Post-stroke delirium and significant risk factors from bivariate analysis Associated Risk factors from Bivariate Analysis df P-Value AOR AOR with 95% C.I Lower Upper Age greater than 60 1 0.016* 19.110 1.723 211.979 History of HTN 1 0.823 1.305 .127 13.371 History of DM 1 0.160 4.162 .570 30.398 History Cardiac Illness 1 0.831 .818 .129 5.177 Presence of Sepsis 1 0.029* 8.373 1.244 56.366 Presence of Polypharmacy 1 0.000* 157.797 10.204 244.0 Presence of Electrolyte Derangement 1 0.005* 65.202 3.424 124.1 4. Discussion Stroke is a global health challenge that often leads to death or impairment. The WHO warns that stroke will become a widespread crisis in the current century. [34] Delirium, a multifaceted mental disorder, has been linked to various conditions and interventions. Among these, strokes emerge as significant triggers for its onset. [ 4 ] Although no prior studies on post-stroke delirium existed in our setting, our research revealed a remarkably high prevalence of post-stroke delirium at 25.7%. Hypoactive Delirium leading (12.9%) followed by Mixed Delirium (6.9%). In comparison to studies conducted in Germany (10.7%) and Egypt (20.3%), our findings are notably higher. However, when compared to the study from King’s College London, our result is slightly lower (28% vs. 25.7%). The mean (SD) age of our study participants was 56.05 ± 15.38 years, which is notably younger than the Egyptian study population with a mean age of 60.7 years. This finding underscores that our stroke patients tend to be relatively younger. The possible explanation lies in the prevalence of poorly controlled hypertension and a significant proportion of patients with cardio embolic stroke. The latter may be attributed to valvular heart disease resulting from rampant rheumatic fever. Regarding the association between age and the development of post-stroke delirium, our results indicate that patients aged 60 or older are significantly linked (P-value = 0.016) to the occurrence of post-stroke delirium. This aligns with existing literature, which consistently emphasizes that advanced age is a risk factor for delirium development. In our study, 45% of participants were male, while 55% were female, indicating a slight female predominance. This contrasts with the Egyptian study, where males were predominant (45.9% females vs. 54.1% males). The difference may be attributed to women’s better health-seeking behavior in our setting. Regarding the relationship between sex and incidence of delirium, we found no significant difference between male and female stroke patients. Interestingly, this aligns with existing literature, which consistently does not identify sex as a risk factor for the development of post-stroke delirium. In the context of comorbid medical illnesses observed in participants who presented with stroke, several key findings emerged. Hypertension was notably prevalent, affecting 63.3% of the participants. Diabetes mellitus was present in 20.8%, and cardiac illness was identified in 30.7% of the cases. When comparing these three major comorbidities with data from an Egyptian study, our findings revealed lower prevalence rates in all 3 comorbidities. This discrepancy can be attributed to several factors, but mainly our majority of patients lack preceding health checkups, leading to a higher incidence of undiagnosed hypertension, diabetes, and cardiac illnesses. In our study, acute ischemic stroke patients exhibited a 69.2% prevalence of delirium, contrasting with previous findings that favored hemorrhagic stroke. Regarding stroke laterality, Right Hemisphere strokes showed a 50% delirium prevalence, although statistical significance was not reached (p-value = 0.8). Prior studies yielded conflicting results, with some favoring the Right Hemisphere and others implicating the Left Hemisphere in post-stroke delirium risk. In our study, we observed that sepsis is a notable complication in stroke patients, with a prevalence of 18.8%. This sepsis risk arises from various sources, including aspiration pneumonia, urinary tract infections, and other infectious processes. Furthermore, the presence of sepsis is statistically associated with the development of delirium (p-value = 0.02). Regarding electrolyte derangement, 15% of our Acute Stroke patients exhibited abnormalities. Among these, Hyponatremia emerged as the major culprit, with a striking 86% proportion. In our study, we investigated the temporal dynamics of delirium development following admission. Notably, the median day for delirium onset was found to be approximately 3 days, with a narrow range of variability (± 1 day). These findings underscore the importance of early monitoring and intervention to mitigate the impact of delirium in hospitalized patients. 5. Conclusion Our Study showed that Post Stroke Delirium occurs in a quarter of patients admitted with a Diagnosis of Acute Stroke, and the Identified risk factors were Age greater than 60, Polypharmacy, Presence of Sepsis and Electrolyte Derangement, Medical professionals responsible for caring for acute stroke patients should be vigilant in identifying those at higher risk of developing post-stroke delirium. Additionally, they should focus on preventing and treating possible precipitating factors such as infections or electrolyte abnormalities. Incorporating delirium screening into routine patient assessments is crucial. 6. Recommendation Risk Assessment and Vigilance: Healthcare professionals caring for acute stroke patients should remain vigilant in identifying individuals at higher risk of developing post-stroke delirium. Monitoring patients closely, especially those who are over 60 years old and those with a history of Polypharmacy, sepsis, or electrolyte derangement. Preventive Measures: Proactively address potential precipitating factors, such as infections or electrolyte imbalances. Incorporate Delirium Screening into Routine Stroke care. Declarations All information collected was used solely for the intended purpose. Personal Identifier Information (PII), including names of patients, was not included in the questionnaire. Codes were used instead and completed questionnaires were stored safely by the Investigator. Data from the research is Available with the Primary investigator for purposes of Publication or additional Scrutiny. Human Ethics and consent to participate declaration is attached. Proposal approval was obtained before the beginning of data collection from Addis Ababa University College of Health Science IRB and Research and Publication Committee (RPC) of the Department of Neurology, College Health Sciences (CHS) TASH. Additionally Ethical clearance was approved by Ethics committee of Tikur Anbessa Specialized Hospital. This research received no Funding or grant from any funding agency in the public, commercial, or nonprofit sectors. All authors declare that they have no conflicts of interest. Consent was asked from all participating individuals and only those who consented were included in the study. Author Contribution A) Dr Beruk Ketema Primary invesgator, prepared the main manuscript text, prepared Figures B) Prof Getahun Mengistu Reviewed the manuscriptC) Dr Dereje Melka Reviewed the manuscriptD) Dr Yared Zenebe Reviewed the manuscript E) Dr Mehila Zebenigus Reviewed the manuscript F) Dr Feryat Leul assisted in writing manuscript A,B,C,D Neurologist, Department of Neurology, College of Health Science, Addis Ababa University, Zambia Street, Addis Ababa, EthiopiaE Neurologist, Yehulshet specialty ClinicF Internsit, Department of Internal Medicine , College of Health Science, Addis Ababa University, Zambia Street, Addis Ababa, Ethiopia References Inouye SK. The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical. Am J Med. 1994;97(3):278. Setters B, Solberg LM, Delirium Prim C. 2017; 44 (3):541. Mach JR Jr, Dysken MW, Kuskowski M, Richelson E, Holden L. 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Delirium on stroke units: a prospective, multicentric qualityimprovement project. Mcmanus J, Pathansali R, Hassan H, Ouldred E, Cooper D. Robert Stewart, Alastair Macdonald, Stephen Jackson2009.The course of delirium in acute stroke. Christian Boßelmann J, Zurloh M-I, Stefanou V, Stadler Y, Weber H, Lerche S, Poli. Ulf Ziemann, and Annerose Mengel 2019. Delirium Screening in Aphasic Patients With the Intensive Care Delirium Screening Checklist (ICDSC): A Prospective Cohort Study. Sandeep Grover and Natasha Kate. 2012. Assessment scales for delirium: A review. Wang Q, Tang XN, Yenari MA. The inflammatory response in stroke. J Neuroimmunol. 2007;184(1–2):53–68. Akin Ojagbemi M, Owolabi. Toyin Bello, and Olusegun Baiyewu Stroke severity predicts poststroke delirium and its association with dementia: Longitudinal observation from a low-income setting. World Gastroenterology Organization. WGO Practice Guideline. The World Health Organization (WHO). Definition of Polypharmacy, Sleep Deprivation and alcohol abuse. Stroke Manual. TOAST Classification of stroke. Additional Declarations No competing interests reported. Supplementary Files PostStrokeDeliriumStudySPSS1.sav Cite Share Download PDF Status: Published Journal Publication published 19 Mar, 2025 Read the published version in BMC Neurology → Version 1 posted Editorial decision: Revision requested 14 Aug, 2024 Reviews received at journal 03 Aug, 2024 Reviewers agreed at journal 28 Jul, 2024 Reviews received at journal 24 Jul, 2024 Reviewers agreed at journal 10 Jul, 2024 Reviewers invited by journal 09 Jun, 2024 Editor invited by journal 04 Jun, 2024 Submission checks completed at journal 03 Jun, 2024 Editor assigned by journal 03 Jun, 2024 First submitted to journal 07 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4380767","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":313665347,"identity":"1258ac89-08d2-45e3-82b6-96689884e7d5","order_by":0,"name":"Beruk Ketema","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+0lEQVRIiWNgGAWjYBACAyBmbGBIgPA+IASJ0MIDYsxACOLWhqKFmYcYLebsvc8kZzCkydmzdyd+tqmxS2xgb94mwVDxB6cWy57jZpIbGHKMeXjObpbOOZac2MBzrEyC4Qweh91IY5N8wFCR2CORu0E6h405sUEix0yCsQ2PlvvPwFrqe+Tfbv5t8a8+sUH+DVDLP3y2sLGBHJbAI8G7TZqx7TDQFh6glgbcWix70pgtZxikGfacyd1m2dt33LiNJ63YIuGYMU4t5uzHGG/2VCTLs7ef3Xzjx7dq2X72wxtvfKiRw6kF6jwkNhuISCCgYRSMglEwCkYBfgAAhORM18I3TDQAAAAASUVORK5CYII=","orcid":"","institution":"Addis Ababa University","correspondingAuthor":true,"prefix":"","firstName":"Beruk","middleName":"","lastName":"Ketema","suffix":""},{"id":313665348,"identity":"4728c78c-05d7-4830-b5b4-67e12c2a6157","order_by":1,"name":"Getahun Mengistu","email":"","orcid":"","institution":"Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Getahun","middleName":"","lastName":"Mengistu","suffix":""},{"id":313665349,"identity":"f923e859-6d52-4140-a5a6-bf9aca032183","order_by":2,"name":"Dereje Melka","email":"","orcid":"","institution":"Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Dereje","middleName":"","lastName":"Melka","suffix":""},{"id":313665350,"identity":"4723f57a-928d-48f5-bba3-4f68c5196727","order_by":3,"name":"Yared Zenebe","email":"","orcid":"","institution":"Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Yared","middleName":"","lastName":"Zenebe","suffix":""},{"id":313665351,"identity":"b246435b-24d2-404c-8a00-301009cd1866","order_by":4,"name":"Mehila Zebenigus","email":"","orcid":"","institution":"Yehulshet speciality Clinic","correspondingAuthor":false,"prefix":"","firstName":"Mehila","middleName":"","lastName":"Zebenigus","suffix":""},{"id":313665352,"identity":"49a07a73-4bd2-47dc-969d-9f61d7e0adfe","order_by":5,"name":"Feryat Leul","email":"","orcid":"","institution":"Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Feryat","middleName":"","lastName":"Leul","suffix":""}],"badges":[],"createdAt":"2024-05-07 06:44:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4380767/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4380767/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12883-025-04114-7","type":"published","date":"2025-03-19T15:58:16+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":58517113,"identity":"70f695ec-006f-4a8f-8b66-d647cbd47f92","added_by":"auto","created_at":"2024-06-17 16:54:11","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":13780,"visible":true,"origin":"","legend":"\u003cp\u003eList of associated Medical comorbidities among the acute stroke participants at TASH, Y12HMC, and YSC from August 1-December 31, 2023 G.c.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4380767/v1/70edee8e24c5753e2d1bece9.png"},{"id":79120686,"identity":"390dd930-a575-4078-a4dc-8b294bba95d1","added_by":"auto","created_at":"2025-03-24 16:10:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":663758,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4380767/v1/c7a73675-b2c7-4a98-87b3-d5afab5b4ef4.pdf"},{"id":58517802,"identity":"266482ae-5ace-4f25-9a55-0b0dc1ac0083","added_by":"auto","created_at":"2024-06-17 17:02:12","extension":"sav","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":13608,"visible":true,"origin":"","legend":"","description":"","filename":"PostStrokeDeliriumStudySPSS1.sav","url":"https://assets-eu.researchsquare.com/files/rs-4380767/v1/b98dd4dcb4c3d8d4f3f29c8e.sav"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Prevalence of Post Stroke Delirium and associated risk factors a multicenter prospective study in hospitalized patients at Tikur Anbessa Specialized Hospital, Yekatit 12 Hospital Medical College and Yehulshet Specialty Clinic, Addis Ababa, Ethiopia.","fulltext":[{"header":"1. Introduction","content":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003e \u003cstrong\u003eDelirium and Confusional States\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eThese conditions frequently manifest in patients with medical illnesses, particularly among the elderly. \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDelirium is a sudden alteration in mental state marked by irregular and varying levels of attention. It involves a disruption in consciousness levels and a decreased capacity to concentrate, guide, change, and maintain attention. \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eConsciousness requires both arousal and attentiveness; if one is conscious \u003cem\u003eof something\u003c/em\u003e. The brainstem and diencephalon's reticular activating system mediates arousal. Attentiveness depends on the cerebral cortex, especially polymodal association areas. \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDelirium (also known as acute Confusional state) is an organically caused decline from a previous baseline of mental function that develops over a short period, typically hours to days.\u003c/p\u003e \u003cp\u003eA variety of terms are used to describe delirium, including acute brain failure, encephalopathy, acute Confusional state, and postoperative or intensive care unit (ICU) psychosis. \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn the DSM-5, the American Psychiatric Association identifies five essential characteristics that define delirium:\u003c/p\u003e \u003cp\u003e1. \u003cb\u003eAttention Disturbance\u003c/b\u003e: Reduced ability to direct, focus, sustain, and shift attention, coupled with impaired awareness.\u003c/p\u003e\u003cp\u003e2. \u003cb\u003eRapid Onset\u003c/b\u003e: Develops over a short period (usually hours to days), differs from baseline, and fluctuates throughout the day.\u003c/p\u003e \u003cp\u003e3. \u003cb\u003eCognitive Impairment\u003c/b\u003e: Additional deficits in memory, orientation, language, visuospatial abilities, or perception.\u003c/p\u003e \u003cp\u003e4. \u003cb\u003eExclusion Criteria\u003c/b\u003e: Not attributable to another neurocognitive disorder, and not occurring during severe arousal reduction (e.g., coma).\u003c/p\u003e\u003cp\u003e5. \u003cb\u003eEtiological Evidence\u003c/b\u003e: Supported by history, physical examination, or lab findings related to medical conditions, substance use, or medication side effects.\u003c/p\u003e\u003cp\u003eFurthermore, delirium may exhibit psychomotor disturbances (hypoactivity, hyperactivity) and variable emotional states (fear, depression, euphoria, perplexity).\u003c/p\u003e \u003cp\u003eThe biological basis of delirium and confusion is not well understood in part because it is difficult to study severely ill patients, but humoral and Neurotransmitter mechanisms have been hypothesized.\u003c/p\u003e \u003cp\u003eDelirium is a multifactorial disorder. Factors that increase the risk for delirium and Confusional states can be classified into those that increase baseline vulnerability and those that precipitate the disturbance. \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe most commonly identified risk factors are underlying brain diseases such as stroke, dementia, or Parkinson's disease; these are present in nearly one-half of older patients with delirium.\u003c/p\u003e \u003cp\u003eNumerous and diverse factors can cause delirium; some prominent ones are infection, dehydration, immobility (including the use of restraints), malnutrition, Polypharmacy (especially psychoactive medicines), and the use of bladder catheters. There are multiple Drugs believed to cause or prolong delirium or Confusional states like Anticholinergic, Analgesics, and other varied Medications. \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDelirium develops over hours to days and typically persists for days and even months. The most useful characteristic for distinguishing delirium from dementia is the acuteness of the presentation.\u003c/p\u003e \u003cp\u003eIn addition, the features of delirium are not stable, typically becoming worse in the evening and at night. It is not unusual for a patient with delirium to appear relatively lucid during morning rounds. \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAs mentioned previously, clinicians often fail to recognize delirium; in some reports, this happens in more than 70% of cases. Behavioral problems or cognitive impairment may be readily apparent but wrongly attributed to the patient's age, dementia, or other mental disorders. \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e "},{"header":"2. Methods","content":"\u003cp\u003eStudy Area and Period\u003c/p\u003e\u003cp\u003eStudy Area\u003c/p\u003e\u003cp\u003e1. Tikur Anbessa Specialized Hospital: Being a multifunctional tertiary care university-affiliated hospital, Tikur Anbessa serves as a pivotal location for conducting the study. The presence of a dedicated Stroke unit, complete with an organized team consisting of senior neurologists, residents, and trained nurses, illustrates a substantial infrastructure for stroke patient care. The existence of a comprehensive protocol and treatment guidelines further reinforces the hospital's commitment to stroke management. The average number of stroke patients per month at TASH is 16.\u003c/p\u003e\u003cp\u003e2. Yekatit 12 Hospital Medical College: As another prominent hospital in the capital city, Yekatit 12 Medical College Hospital provides additional resources and networks for the study. The availability of key departments, including Emergency, ward, and Outpatient services, broadens the scope for potential collaboration and patient recruitment.\u003c/p\u003e\u003cp\u003e3. Yehulshet Specialty Clinic: with its specialty in neurological and internal medicine, offers a unique setting that complements the capabilities of the hospitals. The clinic's focus on neurological specialties and wide range of medical services adds diversity and depth to the study's potential participant pool.\u003c/p\u003e\u003cp\u003eIn addition to the individual strengths of each location, the collective impact of incorporating diverse clinical settings into the study has the potential to yield comprehensive insights into the prevalence of delirium in stroke patients and associated risk factors. The robust setup of the stroke unit at TASH, combined with the broader medical services at both hospital locations and the focused expertise of YSC, presents a network of resources and knowledge that can enhance the study's outcomes.\u003c/p\u003e\u003cp\u003eThe inclusion of multiple institutions within the study not only broadens the geographical reach but also contributes to the diversification of patient demographics and treatment approaches, enriching the data and findings.\u003c/p\u003e\u003cp\u003eGiven the extensive facilities, specialized care, and collective expertise available within these settings, the study promises to be well-positioned for success.\u003c/p\u003e\u003cp\u003eStudy Period\u003c/p\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003eThe Study will be conducted at Tikur Anbessa Specialized Hospital, Yekatit 12 Medical College Hospital, and Yehulshet Specialty Clinic in Addis Ababa, Ethiopia from August 1, 2023 to December 31, 2023.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e\u003cp\u003eStudy Design\u003c/p\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003eA 5-month Observational prospective Cohort study from August 1 2023 G.C to December 31 2023 G.C.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e\u003cp\u003eSource Population\u003c/p\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003eAll Acute Stroke Patients Admitted to the Ward, ER, and Stroke Unit at TASH, Y12HMC, and YSC.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e\u003cp\u003eSampled population\u003c/p\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003ePatients Admitted during the study period were considered as sample Population.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e\u003cp\u003eInclusion Criteria\u003c/p\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003ePresent ischemic or hemorrhagic stroke including TIA, and patients with cerebral venous thrombosis.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e\u003cp\u003eExclusion Criteria\u003c/p\u003e \u003cp\u003e1. Absence of consent for research by the patients themselves or legal representatives;\u003c/p\u003e \u003cp\u003e2. Patients with initial stroke-like symptoms that could not be confirmed as stroke.\u003c/p\u003e\u003cp\u003e3. Patients who have underlying Cognitive disorders like Dementia\u003c/p\u003e \u003cp\u003e4. Patient with an unstable medical condition requiring immediate medical or surgical management\u003c/p\u003e \u003cp\u003e5. Patients with Richmond Agitation Sedation Scale (RASS) score − 3 to -5 and patients who are unable to be assessed for delirium.\u003c/p\u003e \u003cp\u003e6. Acute Stroke Patients with Wernicke's Aphasia.\u003c/p\u003e \u003cp\u003eSample Size and Sampling Technique\u003c/p\u003e\u003cp\u003eThe actual sample size was determined by using the single population proportion formula, where the following assumptions were considered: 95% confidence interval and 5% margin of error. All patients admitted to the stroke unit during the period of data collection were selected to be included in the study. To determine sample size a p-value of 50% was taken since there was no previous study conducted in our country, 10% non-responder rate was added to the calculated sample size. The sample size was deducted by the finite population correction formula because our source of population was less than 10,000 patients. Making the final sample size 101. During the Data collection Amendment was requested from the Department to add a sampling population since the sample size was not being made from the stroke unit alone.\u003c/p\u003e\u003cp\u003eAll Patients admitted to the stroke unit, ward at TASH, Y12HMC, and YSC in the study period were included in the study if they didn’t have one of the Exclusion criteria, RAAS was used to assess the arousability of the patient and to check the premorbid cognitive disturbances respectively, we used the RAAS score of 1 to 4 to define hyperactive delirium and Hypoactive delirium of 0 to -3, patients were assessed for delirium using the well-validated CAM tool as soon as they are admitted to the stroke unit and they were screened for any of the Risk factors that are listed and they were followed in the stroke unit and were be screened every 8–12 hours until they are discharged and transferred to another inpatient setting, Additionally, the total duration of admission and the Outcome of each patient was followed.\u003c/p\u003e\u003cp\u003eData Collection Instrument, Procedure and Method\u003c/p\u003e\u003cp\u003eData was collected using an interviewer-administered questionnaire which was adapted from previously published studies with some modifications to ensure applicability to our current study, after it was checked for validity and reliability after pretesting. The questionnaire consists of questions on sociodemographic factors, medical history, and history of drug intake, substance use, pain control, environmental stressors, and more.\u003c/p\u003e\u003cp\u003eStudy Variables\u003c/p\u003e\n\u003ch3\u003eIndependent\u003c/h3\u003e\n\u003cp\u003e• Age, Gender, Education, Address, Diagnosis at admission, Comorbidities, Nutritional Status, Type of Stroke and Severity, Administered Medication during hospitalization, The presence of psychiatric disorders or Dementia before admission, Hearing and visual impairment, History of Alcohol abuse, Immobilization, Use of Physical restraints, Environmental conditions, History of catheterization and Urinary Retention, Constipation, Surgical Procedures, Electrolyte Imbalance Polypharmacy, Poor pain control, Sleep Deprivation, and Place of admission.\u003c/p\u003e\n\u003ch3\u003eDependent\u003c/h3\u003e\n\u003cp\u003e• Prevalence of delirium in stroke unit patients of Tikur Anbessa.\u003c/p\u003e \u003cp\u003eOperational Definitions\u003c/p\u003e \u003cp\u003e• Constipation - Fewer than three bowel movements (BMs) per week.\u003c/p\u003e \u003cp\u003e• Polypharmacy – The Concurrent use of 5 or more medications\u003c/p\u003e \u003cp\u003e• Sleep Deprivation – defined as less than 6 hours of sleep per night\u003c/p\u003e \u003cp\u003e• Alcohol abuse is defined as \u003cem\u003e\u0026gt;\u003c/em\u003e 21 units per week for males and 15 units per week for females.\u003c/p\u003e \u003cp\u003e• Stroke of Undetermined Etiology – 2 more potential causes of stroke were identified, but no identified etiology was identified despite extensive investigation or incomplete diagnostic evaluation.\u003c/p\u003e \u003cp\u003eData quality control\u003c/p\u003e \u003cp\u003e• The Investigator has examined the appropriateness of the methodologies followed. The questionnaire was reviewed for completeness and pre-testing was done.\u003c/p\u003e \u003cp\u003eThe questionnaires were pre-tested on 5% of the sample in a similar setting, which was not part of the study.\u003c/p\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e Filled questionnaires were checked for completeness and consistency of information and once weekly during data collection by the investigator.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e The template was checked for internal consistency and any inconsistency or ambiguity was addressed in time.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e The authors confirm that the data supporting the findings of this study are available within its supplementary materials.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003cp\u003eEthical clearance\u003c/p\u003e \u003cul\u003e\u003cli\u003e\u003cp\u003e All information collected was used solely for the intended purpose. Personal Identifier Information (PII), including names of patients, was not included in the questionnaire. Codes were used instead and completed questionnaires were stored safely by the Investigator.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e Data from the research is Available with the Primary investigator for purposes of Publication or additional Scrutiny.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e • Proposal approval was obtained before the beginning of data collection from Addis Ababa University College of Health Science IRB and Research and Publication Committee (RPC) of the Department of Neurology, College Health Sciences (CHS) TASH.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e • Additionally Ethical clearance was approved by Ethics committee of Tikur Anbessa Specialized Hospital.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e This research received no specific grant from any funding agency in the public, commercial, or nonprofit sectors.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e All authors declare that they have no conflicts of interest.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e • Consent was asked from all participating individuals and only those who consented were included in the study.\u003c/p\u003e"},{"header":"3. Result","content":"\u003cp\u003eSocio-demography\u003c/p\u003e\u003cp\u003eA total of 101 patients were included in the study. The majority of the study subjects' age is greater than 60, with the mean (SD) age of the study participants being 56.05 ± 15.38 years, with the youngest patient being 22 and the oldest patient being 88 years. 40.6% of the cases were from TASH, 31.7% were from Y12HMC and 27.7% were from YSC. The majority of Patients 87.1% were from Addis Ababa and 12.9% of the participants were from Different regions of Ethiopia like Oromia, Amhara, and SNNPR. The majority 56 (55.4%) of the patients were females. The majority of the participants 76.2% were Orthodox Christians. 80.2% were married and 41.6% had Primary School as their Level of education.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic and behavioral characteristics of the study participants at TASH, Y12HMC, and YSC from August 1-December 31, 2023 G.c.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18–34\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.9%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35–59\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.6%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e≥ 60\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46.5%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44.6%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55.4%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducational Status\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnable to Read and Write\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.9%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary School\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.6%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary School\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.8%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma and Above\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.8%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80.2%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.9%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.0%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.0%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChristian\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76.2%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.8%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.9%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eMedical comorbidities\u003c/p\u003e\u003cp\u003eFrom a total of 101 patients, 63.4% of them have Hypertension, 20.8% of them have Diabetes and around 30.7% of them have Cardiac comorbidity which is predominantly chronic rheumatic valvular heart disease. 4% of them had a history of known malignancy and 18.8% of them Developed Sepsis through their stay in the Hospital. And when we see their History of substance use 9.9% of the participants have recent Alcohol abuse, 4% of them smoked Cigarettes and 5.9% chewed Khat.\u003c/p\u003e\u003cp\u003eThe Data also showed that Polypharmacy is as high as 31.7% and there was Benzodiazepine use in 5% of the Participants because they developed a complication of seizure during their stay at the Hospital. And 15% of the Participants have Developed Electrolyte Derangement like Hypernatremia and Hypernatremia.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSubstance use and iatrogenic risk factors for the development of Post post-stroke delirium in study participants at TASH, Y12HMC, and YSC from August 1-December 31, 2023 G.c.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAlcohol Abuse\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRecent Use of Alcohol\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.9%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo Use of Alcohol\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90.1%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCurrent Smoker\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmoker\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.0%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-Smoker\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96.0%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of chewing chat\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChews Khat\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.9%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon Khat Chewer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94.1%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePresence of Polypharmacy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePolypharmacy Present\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.8%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo Polypharmacy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78.2%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePresence of Visual impairment\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHas Visual Impairment\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.9%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo Visual Impairment\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94.1%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBenzodiazepine use\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUse of Benzodiazepine\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.0%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo Benzodiazepine Use\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95.0%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDid the patient have any Electrolyte derangements?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHave Electrolyte Derangement\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.0%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo Electrolyte Derangement\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85.0%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003eType of Stroke\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eWhen we see the type of stroke 66.3% of them developed Acute ischemic stroke 26.7% of them had Hemorrhagic stroke and the remaining 6.9% of them developed CVT, And from the Acute ischemic strokes 47.8% of the participants had large artery stroke, 34.3% Cardio embolic stroke, 10.4% small vessel occlusion, 1.5% had stroke of other determined Etiology and 6% had stroke of undetermined etiology and when we see the laterality of the stroke majority of them 53.5% had Right sided Stroke, 41.6% of them were Left-Sided and 5% had no laterality.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStroke Subtypes and Laterality of Stroke of the study participants at TASH, Y12HMC, and YSC from August 1-December 31, 2023 G.c.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eStroke Type\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcute Ischemic Stroke\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66.3%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcute Hemorrhagic Stroke\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26.7%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCVT\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.9%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eSubtype of Ischemic stroke(TOAST)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLarge Artery Stroke\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47.8%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCardio-embolic Stroke\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.3%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmall Vessel Occlusion\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.4%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStroke of other Determined Etiology\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.5%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStroke of Undetermined Etiology\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.0%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eLaterality of Stroke\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight Hemisphere\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53.5%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft Hemisphere\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.6%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo Laterality\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.0%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStroke Subtypes and Laterality of Stroke and Development of Delirium.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eStroke Subtypes and laterality of Stroke with Development of Delirium\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c3\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency of Delirium\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eStroke Type\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcute Ischemic Stroke\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69.2%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcute Hemorrhagic Stroke\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30.8%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCVT\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eSubtype of Ischemic stroke(TOAST)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLarge Artery Stroke\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55.6%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCardio-embolic Stroke\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.8%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmall Vessel Occlusion\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.7%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStroke of other Determined Etiology\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStroke of Undetermined Etiology\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eLaterality of Stroke\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight Hemisphere\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.0%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft Hemisphere\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46.2%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo Laterality\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.8%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003ePrevalence of Post Stroke Delirium and Associated Risk factors\u003c/p\u003e\u003cp\u003eOut of 101 patients, 26(25.7%) had Post-stroke Delirium, Age, Gender, Type of stroke, history of hypertension, history of Diabetes, history of Cardiac illness, history of alcohol abuse, smoking cigarette and chewing khat, Presence of Polypharmacy, presence of sepsis, presence of electrolyte imbalance, sleep deprivation, Benzodiazepine use, constipation were individually assessed with Bivariate analysis and those statistically significant were further put into multivariate logistic regression. Upon Multivariate Logistic Regression Age Greater than 60(AOR = 19.1, 95% CI (1.7–211) p = 0.016, Presence of Sepsis (AOR = 8.3, 95% CI (1.2–56) P = 0.029, Presence of Polypharmacy (AOR = 157, 95% CI (10.2–244) P = 0.0001, Presence of Electrolyte Derangement (AOR = 65.2, 95% CI (3.4-124.1) P = 0.005 were statistically significant.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate Logistic regression analysis between the development of Post-stroke delirium and significant risk factors from bivariate analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eAssociated Risk factors from Bivariate Analysis\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAOR\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eAOR with 95% C.I\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge greater than 60\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.016*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19.110\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.723\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e211.979\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHistory of HTN\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.823\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.305\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.127\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e13.371\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHistory of DM\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.160\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.162\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.570\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e30.398\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHistory Cardiac Illness\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.831\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.818\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.129\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5.177\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresence of Sepsis\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.029*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.373\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.244\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e56.366\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresence of Polypharmacy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e157.797\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.204\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e244.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresence of Electrolyte Derangement\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.005*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e65.202\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.424\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e124.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eStroke is a global health challenge that often leads to death or impairment. The WHO warns that stroke will become a widespread crisis in the current century. [34] Delirium, a multifaceted mental disorder, has been linked to various conditions and interventions. Among these, strokes emerge as significant triggers for its onset. \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eAlthough no prior studies on post-stroke delirium existed in our setting, our research revealed a remarkably high prevalence of post-stroke delirium at 25.7%. Hypoactive Delirium leading (12.9%) followed by Mixed Delirium (6.9%). In comparison to studies conducted in Germany (10.7%) and Egypt (20.3%), our findings are notably higher. However, when compared to the study from King’s College London, our result is slightly lower (28% vs. 25.7%).\u003c/p\u003e\u003cp\u003eThe mean (SD) age of our study participants was 56.05 ± 15.38 years, which is notably younger than the Egyptian study population with a mean age of 60.7 years. This finding underscores that our stroke patients tend to be relatively younger. The possible explanation lies in the prevalence of poorly controlled hypertension and a significant proportion of patients with cardio embolic stroke. The latter may be attributed to valvular heart disease resulting from rampant rheumatic fever.\u003c/p\u003e\u003cp\u003eRegarding the association between age and the development of post-stroke delirium, our results indicate that patients aged 60 or older are significantly linked (P-value = 0.016) to the occurrence of post-stroke delirium. This aligns with existing literature, which consistently emphasizes that advanced age is a risk factor for delirium development.\u003c/p\u003e\u003cp\u003eIn our study, 45% of participants were male, while 55% were female, indicating a slight female predominance. This contrasts with the Egyptian study, where males were predominant (45.9% females vs. 54.1% males). The difference may be attributed to women’s better health-seeking behavior in our setting.\u003c/p\u003e\u003cp\u003eRegarding the relationship between sex and incidence of delirium, we found no significant difference between male and female stroke patients. Interestingly, this aligns with existing literature, which consistently does not identify sex as a risk factor for the development of post-stroke delirium.\u003c/p\u003e\u003cp\u003eIn the context of comorbid medical illnesses observed in participants who presented with stroke, several key findings emerged. Hypertension was notably prevalent, affecting 63.3% of the participants. Diabetes mellitus was present in 20.8%, and cardiac illness was identified in 30.7% of the cases. When comparing these three major comorbidities with data from an Egyptian study, our findings revealed lower prevalence rates in all 3 comorbidities.\u003c/p\u003e\u003cp\u003eThis discrepancy can be attributed to several factors, but mainly our majority of patients lack preceding health checkups, leading to a higher incidence of undiagnosed hypertension, diabetes, and cardiac illnesses.\u003c/p\u003e\u003cp\u003eIn our study, acute ischemic stroke patients exhibited a 69.2% prevalence of delirium, contrasting with previous findings that favored hemorrhagic stroke. Regarding stroke laterality, Right Hemisphere strokes showed a 50% delirium prevalence, although statistical significance was not reached (p-value = 0.8). Prior studies yielded conflicting results, with some favoring the Right Hemisphere and others implicating the Left Hemisphere in post-stroke delirium risk.\u003c/p\u003e\u003cp\u003eIn our study, we observed that sepsis is a notable complication in stroke patients, with a prevalence of 18.8%. This sepsis risk arises from various sources, including aspiration pneumonia, urinary tract infections, and other infectious processes. Furthermore, the presence of sepsis is statistically associated with the development of delirium (p-value = 0.02).\u003c/p\u003e\u003cp\u003eRegarding electrolyte derangement, 15% of our Acute Stroke patients exhibited abnormalities. Among these, Hyponatremia emerged as the major culprit, with a striking 86% proportion.\u003c/p\u003e\u003cp\u003eIn our study, we investigated the temporal dynamics of delirium development following admission. Notably, the median day for delirium onset was found to be approximately 3 days, with a narrow range of variability (± 1 day). These findings underscore the importance of early monitoring and intervention to mitigate the impact of delirium in hospitalized patients.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eOur Study showed that Post Stroke Delirium occurs in a quarter of patients admitted with a Diagnosis of Acute Stroke, and the Identified risk factors were Age greater than 60, Polypharmacy, Presence of Sepsis and Electrolyte Derangement, Medical professionals responsible for caring for acute stroke patients should be vigilant in identifying those at higher risk of developing post-stroke delirium. Additionally, they should focus on preventing and treating possible precipitating factors such as infections or electrolyte abnormalities. Incorporating delirium screening into routine patient assessments is crucial.\u003c/p\u003e"},{"header":"6. Recommendation","content":"\u003cul\u003e \u003cli\u003e \u003cp\u003eRisk Assessment and Vigilance:\u003c/p\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eHealthcare professionals caring for acute stroke patients should remain vigilant in identifying individuals at higher risk of developing post-stroke delirium.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eMonitoring patients closely, especially those who are over 60 years old and those with a history of Polypharmacy, sepsis, or electrolyte derangement.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePreventive Measures:\u003c/p\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003eProactively address potential precipitating factors, such as infections or electrolyte imbalances.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eIncorporate Delirium Screening into Routine Stroke care.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/li\u003e \u003c/ul\u003e"},{"header":"Declarations","content":"\u003cul\u003e\n \u003cli\u003e All information collected was used solely for the intended purpose. Personal Identifier Information (PII), including names of patients, was not included in the questionnaire. Codes were used instead and completed questionnaires were stored safely by the Investigator.\u003c/li\u003e\n \u003cli\u003eData from the research is Available with the Primary investigator for purposes of Publication or additional Scrutiny.\u003c/li\u003e\n \u003cli\u003eHuman Ethics and consent to participate declaration is attached.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eProposal approval was obtained before the beginning of data collection from Addis Ababa University College of Health Science IRB and Research and Publication Committee (RPC) of the Department of Neurology, College Health Sciences (CHS) TASH.\u003c/li\u003e\n \u003cli\u003eAdditionally Ethical clearance was approved by Ethics committee of Tikur Anbessa Specialized Hospital.\u003c/li\u003e\n \u003cli\u003eThis research received no Funding or grant from any funding agency in the public, commercial, or nonprofit sectors.\u003c/li\u003e\n \u003cli\u003eAll authors declare that they have no conflicts of interest.\u003c/li\u003e\n \u003cli\u003eConsent was asked from all participating individuals and only those who consented were included in the study.\u003c/li\u003e\n\u003c/ul\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA) Dr Beruk Ketema Primary invesgator, prepared the main manuscript text, prepared Figures B) Prof Getahun Mengistu Reviewed the manuscriptC) Dr Dereje Melka Reviewed the manuscriptD) Dr Yared Zenebe Reviewed the manuscript E) Dr Mehila Zebenigus Reviewed the manuscript F) Dr Feryat Leul assisted in writing manuscript A,B,C,D Neurologist, Department of Neurology, College of Health Science, Addis Ababa University, Zambia Street, Addis Ababa, EthiopiaE Neurologist, Yehulshet specialty ClinicF Internsit, Department of Internal Medicine , College of Health Science, Addis Ababa University, Zambia Street, Addis Ababa, Ethiopia\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eInouye SK. The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical. Am J Med. 1994;97(3):278.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSetters B, Solberg LM, Delirium Prim C. 2017; 44 (3):541.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMach JR Jr, Dysken MW, Kuskowski M, Richelson E, Holden L. Jilk KM Serum anticholinergic activity in hospitalized older persons with delirium: a preliminary study. J Am Geriatr Soc. 1995;43(5):491.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCampbell N, Boustani M, Limbil T, Ott C, Fox C, Maidment I, Schubert CC, Munger S, Fick D, Miller D. Gulati R The cognitive impact of anticholinergics: a clinical review. Clin Interv Aging. 2009;4:225. Epub 2009 Jun 9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarcantonio E, Ta T, Duthie E, Resnick NM Delirium severity and psychomotor types: their relationship with outcomes after hip fracture repair. AU, Marcantonio E, Ta T, Duthie E, Resnick. NM J Am Geriatr Soc. 2002;50(5):850.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRobert B, Darof J, Jankovic J, Mazziota. Scott L Pomeroy Bradley\u0026rsquo;s Neurology in Clinical Practice.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDilip V, Jeste, Joseph H. Friedman Psychiatry for Neurologist.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStephen L, Hauser S. Andrew Josephson Harrisons Neurology in Clinical Medicine.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTesfa Mekonen. Getnet, Mihretie, Dereje Assefa, Wubalem Fekadu and Yohannes Mehretie. (March 2015).Magnitude and Associated Factors of Delirium among Hospitalized Patients.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeron, Anteneh. Prevalence and risk factors of delirium in intensive care unit and, emergency department of Tikur Anbessa Specialized University Hospital.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMekonin GT, Olika MK, Wedajo MB. Ashanafi Tolasa Badada, Abebe Dukessa Dubiwak, Tajera Tageza Ilala, and Mamo Nigatu Gebre Prevalence of Emergence Delirium and Associated Factors among Older Patients Who Underwent Elective Surgery: A Multicenter Observational Study.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBethlehem Sileshy Y, Tesfaye. Henok Ababu Magnitude and associated factors of delirium among patients attending emergency department at Jimma medical center, Jimma, southwest Ethiopia, 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMond M, Boucher V, Carmichael P-H et al. (2017). \u003cem\u003eIncidence of delirium in the Canadian emergency department and its consequences on hospital length of stay\u003c/em\u003e: a Prospective observational multi-center cohort study. \u003cem\u003eBMJ Open\u003c/em\u003e 2018; 8: e018190. 10.1136/ bmjopen-2017-018190.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIncidence. and risk factors of delirium among mechanically ventilated patients in African intensive care setting.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMicek ST, Anand NJ, Laible BR, Shannon WD, Kollef MH. Delirium as detected by the CAM-ICU predicts restraint use among mechanically ventilated medical patients.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOutcome of delirium in. critically ill patients: systemic review analysis. (03 June 2015). BMJ 2015; 350.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHan JH, Shintani A, Eden S, Morandi A, Solberg LM, Schnelle J, Dittus RS, Storrow AB, Ely EW. (2010). Delirium in the emergency department: an independent predictor of death within 6 months. Ann Emerg Med. 2010; 56(3):244 252.e1doi:10.1016/j.annemergmed.2010.03.003. Epub 2010 Apr 3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilson JE, Mart MF, Cunningham C, Shehabi Y, Girard TD, MacLullich AMJ, Slooter AJC, Ely E, Wesley. (2020-11-12). Delirium. Nat Reviews Disease Primers.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u003cem\u003eDiagnostic and statistical manual of mental disorders\u003c/em\u003e: DSM-5 TR (Fifth Ed.). Arlington, VA: American Psychiatric Association. 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSiddiqi N, Harrison JK, Clegg A, Teale EA, Young J, Taylor J, Simpkins SA, March. (2016). Interventions for preventing delirium in hospitalized non-ICU patients.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShintani A, Truman B, Speroff T, Gordon SM, Harrell FE et al. April. (2004). Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHales RE, Yudofsky SC, Gabbard GO, editors. The American Psychiatric Publishing textbook of psychiatry. 5th ed. Washington, DC: American Psychiatric Publishing; 2008.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeentjens AF, Rundell J, Rummans T, Shim JJ, Oldham R, Peterson L et al. August. (2012). Delirium: An evidence-based medicine (EBM) monograph for psychosomatic medicine practice, commissioned by the Academy of Psychosomatic Medicine (APM) and the European Association of Consultation-Liaison Psychiatry and Psychosomatics (EACLPP). J Psychosom Res.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLimpawattana P, Panitchote A, Tangvoraphonkchai K, Suebsoh N, Eamma W, Chanthonglarng B4, Tiamkao S. (2015). Delirium in critical care: a study of incidence, prevalence, and associated factors in the tertiary care hospital of older Thai adult.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDelirium epidemiology in. critical care an international study 2010.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeter Nydahl G, Bartoszek A, Binder L, Paschen NG, Margraf. Karsten Witt, Andre Ewers 2017. Prevalence for delirium in stroke patients: A prospective controlled study.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMitasova AMD, Kostalova MPD, Bednarik, Josef MD, Michalcakova PD, Kasparek RPD, Tomas MD, Balabanova PD, Dusek P, Vohanka LPD, Stanislav MD, Ely PD, Wesley E. MD, MPH Poststroke delirium incidence and outcomes Validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU)*.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZaitoun AM, Elsayed DAF, Bothina M. Ramadan* and Hanan Ahmed Abdel Gaffar Assessment of the risk factors and functional outcome of delirium in acute stroke.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFrancisco Jos\u0026eacute; Alvarez-Perez MD, PhD Fatima Paiva. MD 2016 Prevalence and Risk Factors for Delirium in Acute Stroke Patients. A Retrospective 5-Year Clinical Series.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeter Nydahl F, Baumgarte D, Berg M, Bergjan C, Borzikowsky C, Franke D, Green HC, Hansen A, Hauss U, Hansen G. Margraf. 2022. Delirium on stroke units: a prospective, multicentric qualityimprovement project.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcmanus J, Pathansali R, Hassan H, Ouldred E, Cooper D. Robert Stewart, Alastair Macdonald, Stephen Jackson2009.The course of delirium in acute stroke.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChristian Bo\u0026szlig;elmann J, Zurloh M-I, Stefanou V, Stadler Y, Weber H, Lerche S, Poli. Ulf Ziemann, and Annerose Mengel 2019. Delirium Screening in Aphasic Patients With the Intensive Care Delirium Screening Checklist (ICDSC): A Prospective Cohort Study.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSandeep Grover and Natasha Kate. 2012. Assessment scales for delirium: A review.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Q, Tang XN, Yenari MA. The inflammatory response in stroke. J Neuroimmunol. 2007;184(1\u0026ndash;2):53\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkin Ojagbemi M, Owolabi. Toyin Bello, and Olusegun Baiyewu Stroke severity predicts poststroke delirium and its association with dementia: Longitudinal observation from a low-income setting.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Gastroenterology Organization. WGO Practice Guideline.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe World Health Organization (WHO). Definition of Polypharmacy, Sleep Deprivation and alcohol abuse.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStroke Manual. TOAST Classification of stroke.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-neurology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurl","sideBox":"Learn more about [BMC Neurology](http://bmcneurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurl","title":"BMC Neurology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Delirium, Stroke, Tikur Anbessa Specialized Hospital, Yekatit 12 Hospital and Medical College, Yehulshet Specialty Clinic","lastPublishedDoi":"10.21203/rs.3.rs-4380767/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4380767/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePost-stroke delirium, a frequent and significant complication of stroke, manifests as a sudden onset of confusion, altered consciousness, and cognitive decline. Various factors contribute to its occurrence, including old age, multiple comorbidity, electrolyte abnormalities, and infections. The impact of post-stroke delirium on stroke recovery is substantial. It leads to prolonged hospital stays, heightened risk of institutionalization, increased dependence, and elevated mortality rates. As a result, early identification and prompt treatment of post-stroke delirium are imperative for optimizing outcomes in stroke patients.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThe objective of this study is to determine the Prevalence of post-stroke delirium and associated risk factors in hospitalized patients at TASH, Y12HMC, and YSC, Addis Ababa, Ethiopia from August to December 2023 G.c.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eWe performed a prospective observational cross-sectional study, including all the stroke patients admitted to the respective study areas during the study period from August to December 2023 G.c.\u003c/p\u003e","manuscriptTitle":"The Prevalence of Post Stroke Delirium and associated risk factors a multicenter prospective study in hospitalized patients at Tikur Anbessa Specialized Hospital, Yekatit 12 Hospital Medical College and Yehulshet Specialty Clinic, Addis Ababa, Ethiopia.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-17 16:54:07","doi":"10.21203/rs.3.rs-4380767/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-08-14T06:40:57+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-03T05:56:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"167974492189545844252685406130153743542","date":"2024-07-28T07:46:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-25T00:39:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"263814658580830781407068008205730310342","date":"2024-07-10T21:05:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-09T22:08:11+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-06-04T19:27:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-03T07:02:30+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-03T07:02:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Neurology","date":"2024-05-07T06:42:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-neurology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurl","sideBox":"Learn more about [BMC Neurology](http://bmcneurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurl","title":"BMC Neurology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"39a47e57-52eb-4932-a5af-185674b4e48f","owner":[],"postedDate":"June 17th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-03-24T16:07:13+00:00","versionOfRecord":{"articleIdentity":"rs-4380767","link":"https://doi.org/10.1186/s12883-025-04114-7","journal":{"identity":"bmc-neurology","isVorOnly":false,"title":"BMC Neurology"},"publishedOn":"2025-03-19 15:58:16","publishedOnDateReadable":"March 19th, 2025"},"versionCreatedAt":"2024-06-17 16:54:07","video":"","vorDoi":"10.1186/s12883-025-04114-7","vorDoiUrl":"https://doi.org/10.1186/s12883-025-04114-7","workflowStages":[]},"version":"v1","identity":"rs-4380767","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4380767","identity":"rs-4380767","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}