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22. European Stroke Conference 9 Behavioral disorders and post-stroke dementia 9:50 - 10:00 Serotonergic correlation with anger and aggressive behaviour in acute stroke patients: an intensity dependence of auditory evoked potentials (IDAP) study. M. Toscano1, A. Vigano2, F. Puledda3, A. Rocco4, G.L. Lenzi5, V. Di Piero6 “Sapienza” University of Rome, Rome, ITALY1,”Sapienza” University of Rome, Rome, IT-ALY2, “Sapienza” University of Rome, Rome, ITALY3, Charité Campus Benjamin Franklin, Berlin, GERMANY4, “Sapienza” University of Rome, Rome, ITALY5, “Sapienza” University of Rome, Italy Background Anger and aggressive behaviour (AB) after stroke are two of the main post-stroke behavioural manifestations, which could imply both an anger trait (TA) or a state condition of anger (SA). Serotonergic system is thought to play an inhibitory control on aggressive impulse. Nevertheless, whether 5HT has the same role both in TA and in SA, is still debated. IDAP is in-versely related to central 5HT tone. Aim of this study was to evaluate, in acute stroke patients, 5HT system involvement in AB by IDAP. Methods Consecutive subcortical stroke patients were evaluated by clinical and instrumental examinations and compared with age matched healthy controls. IDAP was calculated as the linear amplitude/stimulus intensity function slope on auditory evoked potentials. Spielberger Trait Anger Scale was used to assess AB (overall score ≥22), and SA (pre-post stroke difference >2). Besides, we considered patients having TA, those with an overall score ≥22 and pre-post stroke difference ≤2. Results 20 stroke pa-tients were enrolled (mean age 62 yrs; 10/10 M/F), 10 of which (50%) showed AB, 9 (45%) had TA and 6 (30%) had SA. Patients with AB showed a significantly increased IDAP value, that is a decreased 5HT central tone, in respect to those without anger (p=0.001) and healthy controls (p<0.001). Similarly patients with TA showed higher IDAP than those without TA (p<0.001). On the contrary, patients with SA had a significantly lower IDAP than those without SA (p<0.001), which indicates an increased 5HT tone. Conclusion In acute stroke patients with anger and aggressive behaviour (AB), there is a direct involvement of serotonergic system, with a decreased central 5HT tone. Surprisingly, by grouping stroke patients according to the pres-ence of TA and SA, we found an opposite 5HT feature, suggesting that hypothesis of aggression based on 5HT deficiency needs for further investigations. This data could also be interesting for exploring different possible strategies for AB treatment. 8 Behavioral disorders and post-stroke dementia 9:40 - 9:50 Diagnosing delirium in patients with acute ischemic stroke: What’s delirium and what’s stroke? S.H. Kreisel1, E. Cieplinska-Legge2, M. Guhra3, C. Thomas4 Evangelisches Krankenhaus Bielefeld, Bielefeld, GERMANY1,Evangelisches Krankenhaus Bielefeld, Bielefeld, GERMANY2, Evangelisches Krankenhaus Bielefeld, Bielefeld, GERMA-NY3, Evangelisches Krankenhaus Bielefeld, Bielefeld, GERMANY4 Background: Delirium incidence in patients with acute stroke has been shown to be high (any-where from 2.3 to 66%), morbidity and mortality are dire (OR for inpatient death: 4.71, 95%CI 1.85 – 11.96). However, variability in reports also highlights diagnostic uncertainty. Though focal ischemic injury can lead to symptoms mimicking delirium (e.g. acute confusional state), functional disturbances related to delirium (fluctuation of impaired consciousness, attention, cognition and perception, next to predominantly psychomotor agitation) may be distinct. Stan-dard delirium screening instruments are potentially not specific enough to disentangle clinical features of delirium from stroke – this calls for dedicated tools that take stroke-specifics into account. Methods: In this ongoing trial, we recruited consecutive stroke unit patients (n=156), having had a baseline NIHSS score greater than 2; patients were excluded if neuroimaging or other work-up showed non-ischemic etiology. Patients were initially seen between 24h and 48h post-stroke, and serially thereafter until day 5. Next to standard delirium screening instruments (e.g. Confusion Assessment Method-ICU (CAM-ICU)) and formalized gold standard diagnostic criteria, patients were screened with a set of quick-and-easy non-verbal bedside tools covering the ICD-10 neuropsychological diagnostic criteria for delirium: orientation, attention, executive function/abstraction and immediate recall. Results: The incidence of delirium diagnosis was 17.9% according to ICD-10 criteria. The neu-ropsychological domain-specific tests were better able to discriminate between stroke-associ-ated symptoms and those related to the delirium diagnosis – in comparison to CAM-ICU stan-dard screening . Conclusion: Delirium screening in patients with acute ischemic stroke is potentially complicat-ed by syndromal overlap; testing specific subdomains of neuropsychological functioning asso-ciated with delirium diagnosis may increase screening accuracy. 190 © 2013 S. Karger AG, Basel Scientific Programme


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