149 results match your criteria Confusional States and Acute Memory Disorders

Mixed dementia and hyperactive delirium: a diagnostic challenge.

BMJ Case Rep 2021 May 7;14(5). Epub 2021 May 7.

Department of Acute Medicine, Royal Berkshire NHS Foundation Trust, Reading, UK.

It is well recognised that acute confusion or delirium complicates up to 10% of acute medical admissions. Disorientation in time and place with an impaired short-term memory and conscious level are the hallmarks of an acute confusion. In delirium, disorders of perception may produce restlessness and agitation. Read More

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Glucocorticoids and the Brain after Critical Illness.

Endocrinology 2021 03;162(3)

Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA.

Treatment for critical illness typically focuses on a patient's short-term physical recovery; however, recent work has broadened our understanding of the long-term implications of illness and treatment strategies. In particular, survivors of critical illness have significantly elevated risk of developing lasting cognitive impairment and psychiatric disorders. In this review, we examine the role of endogenous and exogenous glucocorticoids in neuropsychiatric outcomes following critical illness. Read More

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Neuropsychiatric Disorders Due to Limbic Encephalitis: Immunologic Aspect.

Int J Mol Sci 2020 Dec 31;22(1). Epub 2020 Dec 31.

Department of Pediatrics, National Taiwan University Hospital, Taipei 100226, Taiwan.

Limbic encephalitis (LE) is a rare cause of encephalitis presenting as an acute and subacute onset of neuropsychiatric manifestations, particularly with memory deficits and confusion as core features, along with seizure occurrence, movement disorders, or autonomic dysfunctions. LE is caused by neuronal antibodies targeting the cellular surface, synaptic, and intracellular antigens, which alter the synaptic transmission, especially in the limbic area. Immunologic mechanisms involve antibodies, complements, or T-cell-mediated immune responses in different degree according to different autoantibodies. Read More

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December 2020

A 71-year-old man with a rare rhabdoid brain tumour: using a multidisciplinary medical and rehabilitative model of care.

BMJ Case Rep 2020 Jun 11;13(6). Epub 2020 Jun 11.

Physical Medicine & Rehabilitation, Washington University in Saint Louis, Saint Louis, Missouri, USA

Atypical rhabdoid tumours (AT/RTs) of pineal origin are rare in adults with rapid progression and poor prognosis. We present the case of a 71-year-old man with confusion and memory loss who was diagnosed with a pineal AT/RT after genetic analysis. Due to his limited functional capacity and goal to return home with family, a multidisciplinary care approach was essential for coordination of medical management, radiation treatment and acute inpatient rehabilitation. Read More

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Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic.

Lancet Psychiatry 2020 07 18;7(7):611-627. Epub 2020 May 18.

UCL Institute of Mental Health, University College London, London, UK.

Background: Before the COVID-19 pandemic, coronaviruses caused two noteworthy outbreaks: severe acute respiratory syndrome (SARS), starting in 2002, and Middle East respiratory syndrome (MERS), starting in 2012. We aimed to assess the psychiatric and neuropsychiatric presentations of SARS, MERS, and COVID-19.

Methods: In this systematic review and meta-analysis, MEDLINE, Embase, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature databases (from their inception until March 18, 2020), and medRxiv, bioRxiv, and PsyArXiv (between Jan 1, 2020, and April 10, 2020) were searched by two independent researchers for all English-language studies or preprints reporting data on the psychiatric and neuropsychiatric presentations of individuals with suspected or laboratory-confirmed coronavirus infection (SARS coronavirus, MERS coronavirus, or SARS coronavirus 2). Read More

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Treatment of Delirium in Older Persons: What We Should Not Do!

Int J Mol Sci 2020 Mar 31;21(7). Epub 2020 Mar 31.

Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.

The presentation of common acute diseases in older age is often referred to as "atypical". Frequently, the symptoms are neither single nor tissue related. In most cases, the onset of symptoms and diseases is the expression of a diminished reserve with a failure of the body system and imbalance of brain function. Read More

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Cognitive impairment, clinical symptoms and functional disability in patients emerging from the minimally conscious state.

NeuroRehabilitation 2020 ;46(1):65-74

Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.

Background: Although emergence from the minimally conscious state (eMCS) is associated with symptoms including disorientation, memory and attention impairment, restlessness, and significant functional disability, the neurobehavioral profile of eMCS has not been empirically characterized.

Objective: Determine degree of cognitive impairment, presence of clinical symptoms and functional disability at time eMCS in patients with traumatic and non-traumatic brain injury (TBI, nTBI).

Methods: Retrospective observational study of 169 adults (median [interquartile range] age: 51 [29, 62] years; male: 116; TBI: 103) who emerged from MCS based on the Coma Recovery Scale-Revised while in an inpatient Disorders of Consciousness program. Read More

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A Metabolic Brain Pattern Associated With Anti-N-Methyl-D-Aspartate Receptor Encephalitis.

Psychosomatics 2020 Jan - Feb;61(1):39-48. Epub 2019 Sep 5.

PET/CT Molecular Imaging Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.

Background: Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis causes substantial neurological disability. Autoantibodies causing encephalitis directed against the neuronal cell surface or synapse are of diagnostic importance giving the possibility of successful immunotherapy.

Objective: In this study, we aim to provide supporting evidence that brain 18F-FDG-PET may be helpful in identifying likely patterns of regional brain glucose metabolism. Read More

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January 2021

Acute treatment of psychotic symptoms in a newly diagnosed Lewy body dementia patient with an accelerated titration schedule of rivastigmine and de-escalation of antipsychotics.

BMJ Case Rep 2019 Sep 4;12(9). Epub 2019 Sep 4.

Internal Medicine, Mercy Hospital Iowa City, Iowa City, Iowa, USA.

A 76-year-old man presented with complaints of increased confusion, visual hallucinations and decline in memory. He was admitted to the hospital and started on quetiapine 50 mg daily for symptom management. Shortly after, he was diagnosed with Lewy body dementia and started on rivastigmine, a cholinesterase inhibitor (ChEI), at 1. Read More

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September 2019

Acute postoperative pain exacerbates neuroinflammation and related delirium-like cognitive dysfunction in rats.

J Anesth 2019 06 25;33(3):482-486. Epub 2019 Mar 25.

Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.

The acute neuroinflammatory response to surgery may play a key pathogenic role in postoperative delirium (POD). Here, we investigated the contribution of acute postoperative pain to neuroinflammation and related delirium-like behaviors after surgery in adult and aged rats. Animals were assigned into four groups: control, abdominal surgery, surgery with analgesia using local ropivacaine, and surgery with analgesia using systemic morphine. Read More

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Neuropsychological Characteristics of the Confusional State Following Traumatic Brain Injury.

J Int Neuropsychol Soc 2019 03 25;25(3):302-313. Epub 2019 Jan 25.

1Mental Health & Behavioral Sciences,James A. Haley Veterans' Hospital,Tampa,Florida.

Objectives: Individuals with moderate-severe traumatic brain injury (TBI) experience a transitory state of impaired consciousness and confusion often called posttraumatic confusional state (PTCS). This study examined the neuropsychological profile of PTCS.

Methods: Neuropsychometric profiles of 349 individuals in the TBI Model Systems National Database were examined 4 weeks post-TBI (±2 weeks). Read More

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Restructuring Blank Spaces: The Role of Cognitive-Behavioral Interventions for Two Patients With Post-traumatic Amnesia After Severe Traumatic Brain Injury.

Mil Med 2019 01;184(1-2):e266-e271

Department of Psychiatry, University of Illinois College of Medicine, 912 S. Wood Street, MC 913, Chicago, IL.

Differentiation of symptoms associated with post-traumatic amnesia (PTA) versus post-traumatic stress symptoms (PTSS) following trauma presents many treatment challenges among veterans and active duty service members receiving rehabilitation after traumatic brain injury (TBI). The acute phase of rehabilitation poses difficulties for amnestic individuals that may elicit classic PTA symptoms as well as premorbid PTSS, thereby activating maladaptive cognitions and an increase in agitation and arousal. Historically, explicit learning and memory strategies were considered non-efficacious with amnestic individuals until PTA resolves; therefore, rehabilitation therapies have utilized implicit learning in the initial phases of recovery. Read More

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January 2019

Cognitive/affective factors are associated with children's acute posttraumatic stress following pediatric intensive care.

Psychol Trauma 2019 Jan 7;11(1):55-63. Epub 2018 May 7.

Centre of National Research on Disability and Rehabilitation Medicine (CONROD), The University of Queensland.

This study aimed to explore children's experiences and memories of the pediatric intensive care unit (PICU) and identify the relative importance of premorbid, trauma, and cognitive/affective variables associated with acute posttraumatic stress symptoms (PTSS). Participants were 95 children aged 6-16 years admitted to the PICU and their parents. Children completed questionnaires and an interview assessing PTSS, peritrauma affect, and their memory of the admission 3 weeks following discharge. Read More

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January 2019

Involvement of acute neuroinflammation in postoperative delirium-like cognitive deficits in rats.

J Anesth 2018 08 3;32(4):506-517. Epub 2018 May 3.

Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.

Purpose: The purpose of this study was to investigate the age-, time-, and brain region-dependent postoperative neuroinflammatory trajectory, and its association with neurocognitive outcomes in rats.

Methods: Adult and aged rats were randomly assigned to one of three groups: control, isoflurane anesthesia alone, and isoflurane anesthesia with abdominal surgery. On either postoperative day 2 (early phase) or 7 (late phase), all rats were tested for trace and context fear memory retention after acquisition of trace fear conditioning. Read More

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Anteromedial thalamic infarct: a rare presentation.

BMJ Case Rep 2018 May 2;2018. Epub 2018 May 2.

Department of Neurology, Montefiore Hospital and Medical Center, Bronx, New York, USA.

We report a rare presentation of an anteromedial thalamic infarct in a 50-year-old woman with acute onset left eye ptosis, vertical gaze paresis and confusion. MRI identified an acute left anteromedial thalamic infarct with a severe left P1 stenosis. Thalamic infarcts are associated with marked neurobehavioural disturbances with dominant thalamic lesions causing language deficits, verbal perseveration, memory disturbances, abulia and disorientation. Read More

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Tako-tsubo cardiomyopathy with transient global amnesia and cerebellar embolic stroke triggered by existential fear.

Neurol Neurochir Pol 2018 May - Jun;52(3):394-396. Epub 2018 Jan 6.

Rudolfstiftung, Juchgasse 25, A-1030 Wien, Austria. Electronic address:

Background: Embolic stroke is a complication of Tako-Tsubo-cardiomyopathy (TTC), transient left ventricular dysfunction mimicking myocardial infarction without coronary culprit lesion explaining the whole left ventricular dysfunction. Transient global amnesia (TGA) is characterized by sudden onset of anterograde amnesia without compromise of other neurologic functions.

Case Report: A 57 years old female was admitted because of sudden confusion and loss of her memory after emotional stress. Read More

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Latent class analysis of the multivariate Delirium Index in long-term care settings.

Int Psychogeriatr 2019 01 3;31(1):59-72. Epub 2018 May 3.

St. Mary's Hospital Research Centre,Montreal,Quebec,Canada.

ABSTRACTBackground:A few studies examine the time evolution of delirium in long-term care (LTC) settings. In this work, we analyze the multivariate Delirium Index (DI) time evolution in LTC settings.

Methods: The multivariate DI was measured weekly for six months in seven LTC facilities, located in Montreal and Quebec City. Read More

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January 2019

Long-term sequelae of acute respiratory distress syndrome caused by severe community-acquired pneumonia: Delirium-associated cognitive impairment and post-traumatic stress disorder.

J Int Med Res 2018 Jun 2;46(6):2265-2283. Epub 2018 Apr 2.

3 Department of Anesthesiology and Operative Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.

Objective Delirium in critically ill patients is considered a risk factor for various long-term consequences. We evaluated delirium and associated long-term outcomes in patients with acute respiratory distress syndrome with non-H1N1 and H1N1- associated severe community-acquired pneumonia (sCAP) who had been recommended to take antiviral drugs associated with delirious symptoms as adverse effects. Methods Of 64 patients, 42 survivors (H1N1, 15; non-H1N1, 27) were analyzed regarding the relationship between medication and the duration of delirium in the intensive care unit. Read More

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[Accessory symptoms of schizophrenia: E. Bleuler's concept].

N Yu Pyatnitskiy

Zh Nevrol Psikhiatr Im S S Korsakova 2017;117(11):114-121

Mental Health Research Center, Moscow, Russia.

The analysis of E. Bleuler's concept of accessory symptoms of schizophrenia: delusions, hallucinations, depersonalization disorders, splitting of the ego, memory disorders, catatonic symptoms and acute syndromes (manic and melancholic states, acute paranoia, twilight states, clouding of consciousness, confusion, fugues and dipsomania) is presented. The relationship of accessory symptoms with primary and secondary schizophrenic symptoms according to the second concept of E. Read More

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November 2018

Sevoflurane preconditioning ameliorates lipopolysaccharide-induced cognitive impairment in mice.

Exp Anim 2018 May 29;67(2):193-200. Epub 2017 Nov 29.

Department of Anesthesiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.

Systemic inflammation induces brain neuronal inflammation, in turn causing acute cognitive disorders. Furthermore, neuronal inflammation is one cause of postoperative cognitive disorder (POCD) and delirium. However, no sufficiently established pharmacological treatment is available for neurocognitive inflammation. Read More

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Wernicke-Korsakoff syndrome complicated by subacute beriberi neuropathy in an alcoholic patient.

Clin Neurol Neurosurg 2018 01 8;164:1-4. Epub 2017 Nov 8.

Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of Palermo, Italy. Electronic address:

Thiamine (vitamin B1) deficiency is a common condition in alcohol abusers, which can lead to damage of both the peripheral and the central nervous systems. Here we describe the case of an alcoholic patient who presented with acute onset of ataxia, severe weakness of the four limbs, and hypoesthesia and dysesthesia of the distal portion of the upper and lower extremities. The clinical picture also included mental confusion and amnesia. Read More

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January 2018

Validation of the 10-Item Orientation Questionnaire: A New Tool for Monitoring Post-Electroconvulsive Therapy Disorientation.

J ECT 2018 03;34(1):21-25

Objectives: Assessment of post-electroconvulsive therapy (ECT) disorientation at a single time point after ECT treatment may prove an effective and clinically useful method for monitoring the severity of disorientation and predicting ECT-induced retrograde amnesia. In this study, we aimed to validate a novel instrument (10-Item Orientation Questionnaire) developed to assess the level of disorientation after ECT.

Methods: Twenty-four depressed inpatients who were prescribed an acute course of ECT were administered the 10-Item Orientation Questionnaire at 30 minutes after ECT and had time to reorientation assessed at 3 time points after ECT (10, 30, and 60 minutes) at ECT treatments 1 to 3. Read More

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Dementia with Lewy bodies presenting as probable epileptic seizure.

BMJ Case Rep 2017 Sep 27;2017. Epub 2017 Sep 27.

Geriatric Medicine, Eastern Health, Monash University, Victoria, Australia.

We discuss the case of an 83-year-old man admitted to the hospital after losing control of his vehicle due to an unexplained episode of altered consciousness. This occurred on a background of multiple similar episodes associated with acute confusion, superimposed on a gradual cognitive decline spanning 6 years. Organic aetiologies for delirium were excluded and CT and MRI of the brain were negative for cerebrovascular accidents or other epileptogenic foci. Read More

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September 2017

Post-ICU psychological morbidity in very long ICU stay patients with ARDS and delirium.

J Crit Care 2018 Feb 24;43:88-94. Epub 2017 Aug 24.

Department of Emergency Medicine, J.W. Ruby Memorial Hospital, West Virginia University, Morgantown, WV, USA; Department of Emergency Medicine, Vident Medical Center, East Carolina University, Greenville, NC, USA. Electronic address:

Purpose: We investigated the impact of delirium on illness severity, psychological state, and memory in acute respiratory distress syndrome patients with very long ICU stay.

Materials And Methods: Prospective cohort study in the medical-surgical ICUs of 2 teaching hospitals. Very long ICU stay (>75days) and prolonged delirium (≥40days) thresholds were determined by ROC analysis. Read More

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February 2018

Prodromal stage of disease (dementia) with Lewy bodies, how to diagnose in practice?

Geriatr Psychol Neuropsychiatr Vieil 2017 Jun;15(2):196-204

Centre de gériatrie et CM2R Île de France Sud, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France, Université Pierre et Marie Curie et DHU FAST, UMR 8256 (CNRS), Paris, France.

Disease with Lewy bodies or dementia with Lewy bodies (DLB), particularly at the prodromal stage, is a complex disease to diagnose because of different clinical beginnings and variable paths in terms of clinical expression. Thus DLB can be entcountered in different input modes: mild cognitive impairment, depression, acute behavioral disorders, confusion and delirium, or sleep disorders. In the aim to better diagnose the disease, should be sought obviously to search for the key symptoms: fluctuations, hallucinations, extra-pyramidal syndrome, and REM sleep behavior disorder. Read More

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Simultaneous transient global amnesia and right MCA stroke after Valsalva manoeuvre.

BMJ Case Rep 2017 Apr 22;2017. Epub 2017 Apr 22.

Department of Neurology, Hospital Sant Joan Despi Moises Broggi, Sant Joan Despi, Spain.

A 61-year-old man suffered an episode of transient confusion and anterograde amnesia after a Valsalva-related manoeuvre. The MRI diffusion weighted imaging (DWI) sequences showed a left hippocampal and two right parietal lesions that were deemed as acute. The MR angiography disclosed a high-grade stenosis in the right middle cerebral artery as was described by a transcranial colour-coded ultrasound as well. Read More

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What does extinction have to do with confabulation?

Cortex 2017 02 1;87:5-15. Epub 2016 Nov 1.

Laboratory of Cognitive Neurorehabilitation, Division of Neurorehabilitation, University of Geneva, Geneva, Switzerland; Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland.

Behaviourally spontaneous confabulation denotes a distinct syndrome consisting of confabulations that patients act upon, disorientation, and amnesia. It corresponds to the stable form of the original Korsakoff syndrome. While the syndrome may also occur in confusional states and degenerative dementia, this article is about the syndrome as it occurs after acute and focal brain damage. Read More

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February 2017

Major neurocognitive disorder followıng isolated hippocampal ischemıc lesions.

J Neurol Sci 2017 Jan 3;372:496-500. Epub 2016 Nov 3.

Neuropsychology Unit, Neurology Department, Ege University, School of Medicine, İzmir 35100, Turkey.

Background And Purpose: Major cognitive disorder (MND) following vascular events is known as second causes of dementia after Alzheimer's disease (AD). Acute onset MND due to isolated hippocampal infarction has not been recognized as a specific subtype of vascular dementia, and there is no validated criteria for the identification of such cases, either clinically or radiologically.

Results: Among 7200 patients with first-ever ischemic stroke, 22 patients (0. Read More

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January 2017

A Pilot Randomized Controlled Trial of the Feasibility of a Multicomponent Delirium Prevention Intervention Versus Usual Care in Acute Stroke.

J Cardiovasc Nurs 2017 Jan/Feb;32(1):E1-E10

Karen L. Rice, DNS, APRN, ACNS-BC, ANP Nurse Scientist & Director, The Center for Nursing Research, Ochsner Medical Center, New Orleans, Louisiana. Marsha J. Bennett, DNS, APRN, ACRN Professor, Louisiana State University Health Sciences Center, School of Nursing, New Orleans. Linley Berger, MCD, CCC-SLP Speech Language Pathologist, Ochsner Medical Center, New Orleans, Louisiana. Bethany Jennings, MN, APRN, FNP-C Stroke Program Director, Ochsner Medical Center, New Orleans, Louisiana. Lynn Eckhardt, MSN, APRN, GNP-BC Nurse Practitioner, Neurology Clinic, Ochsner Medical Center, New Orleans, Louisiana. Nicole Fabré-LaCoste, PharmD, BCPS, CGP Clinical Pharmacist Residency Program Director, Ochsner Medical Center, New Orleans, Louisiana. David Houghton, MD, MPH Chief, Division of Memory and Movement Disorders, Ochsner Medical Center, New Orleans, Louisiana. Gabriel Vidal, MD Vascular and Interventional Neurologist, Ochsner Medical Center, New Orleans, Louisiana. Toby Gropen, MD Chief, Division of Vascular Neurology, Ochsner Medical Center, New Orleans, Louisiana. Erica Diggs, MD Hospitalist, Division of Internal Medicine, Ochsner Medical Center, New Orleans, Louisiana. Erin Barry, MSN, RN, CNRN Neuro-Critical Care Clinical Nurse Specialist, Ochsner Medical Center, New Orleans, Louisiana. Jennilee St. John, MSN, APRN, AGCNS-BC, CCRN Neuro-Critical Care Clinical Nurse Specialist, Ochsner Medical Center, New Orleans, Louisiana. Sheena Mathew, PharmD Clinical Pharmacist, Ochsner Medical Center, New Orleans, Louisiana. Allison Egger, MPH Biostatistician, Ochsner Medical Center, New Orleans, Louisiana. Stephanie Ryan, DNP, FNP-C Stroke Team Nurse Practitioner, Ochsner Medical Center, New Orleans, Louisiana. Raymond Egger, BSN, RN, CNRN Stroke Central Coordinator, Ochsner Medical Center, New Orleans, Louisiana. David Galarneau, MD Vice Chairman, Department of Psychiatry, Ochsner Medical Center, New Orleans, Louisiana. Kenneth Gaines, MD Director, Ochsner's Neuroscience Institute, Ochsner Medical Center, New Orleans, Louisiana. E. Wesley Ely, MD, MPH Professor of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, and the Veteran's Affairs Geriatric Research Education Clinical Center (GRECC) of the VA Tennessee Valley Healthcare System, Nashville.

Background: Delirium after acute stroke is a serious complication. Numerous studies support a benefit of multicomponent interventions in minimizing delirium-related complications in at-risk patients, but this has not been reported in acute stroke patients. The purpose of this study was to explore the feasibility of conducting a randomized (delirium care) versus usual standardized stroke care (usual care) in reducing delirium in acute stroke. Read More

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February 2018