Delirium as a TIA mimic- are there clinical indicators?

Abstract

Background and Aims: Delirium is a recognized stroke mimic, however, there is little data on delirium as a mimic of transient ischemic attack (TIA). Delirium is prevalent in the same population at risk of TIA and is a well-documented independent predictor of mortality, especially if not recognized and managed properly. Differentiating between TIA and delirium disguised as TIA would assist in proper use of resources. Methods: We conducted a 3-year retrospective cohort study of all suspected TIA presentations to the ED of Ballarat Health Services (BHS). We compared symptomatology and other on-presentation features of neurologist-confirmed TIA cases and re-diagnosed delirium cases. Results: A total of 388 patients were identified as suspected TIA. In the group of TIA mimics on neurologist review, we identified 18 (4.6%) with delirium. We were unable to differentiate between delirium and true TIA on symptomatology alone. However, we did identify certain features more frequently in patients with delirium, namely – older age (p ¼ 0.004), history of recent infection (p ¼ 0.017), premorbid cognitive deficit (p ¼ 0.006), previous delirium (p ¼ 0.018). The categorization of patients with delirium was based on patient records as analyses were retrospective. This is a possible confounder as the actual prevalence of delirium may have been underestimated. Conclusions: Our results indicate that there are potential features in delirium that would allow differentiation from TIA or even stroke. This would require a cross-sectional analysis targeting TIA/stroke admissions to determine if the variables identified are sensitive enough to be used as discriminators. Our project is ongoing