ABSTRACT NUMBER: ESOC2026A1721 RELATIONSHIP BETWEEN RADIOLOGICAL MARKERS ON MRI AND POST-STROKE DELIRIUM

Abstract Background and aims Post-stroke delirium (PSD) is a common complication leading to poor functional outcome. Cerebral small vessel disease (SVD) as a marker for brain frailty and neuro-inflammation may increase vulnerability to delirium. We aimed to investigate whether radiological markers of SVD and neuro-inflammation are associated with the occurrence of delirium. Methods We analyzed a cohort of 211 hospitalized ischemic stroke patients who underwent brain MRI. Delirium, based on DSM-V criteria, was assessed retrospectively the first week of admission using the chart-review method. Markers of SVD and neuro-inflammation (recent small subcortical infarcts (RSSI), lacunes, white matter hyperintensities (WMH), enlarged perivascular spaces (ePVS), cerebral microbleeds, cortical siderosis, global cortical atrophy (GCA), intracranial hemorrhage (hemorrhagic transformation and intracerebral hemorrhage sequelae) and hemorrhagic transformation) were assessed in delirium and non-delirium patients using MRI. Logistic regression analyses were performed with and without adjustment for age, NIHSS, and premorbid cognitive dysfunction to investigate their association with delirium. Results Among the 211 patients (mean age 69, 40% women), 58 developed PSD (27%). In unadjusted analyses, delirium was significantly associated with RSSI, periventricular and total WMH burden, ePVS (centrum semiovale), global cortical atrophy, intracranial hemorrhage and hemorrhagic transformation (Table 1). After adjustment, independent associations remained only for intracranial hemorrhage (aOR 3.50, p=0.004) and hemorrhagic transformation (aOR 2.46, p=0.045) (Table 1). Conclusions Although several MRI markers of SVD and inflammation were associated with PSD, only hemorrhagic transformation of ischemic stroke - with or without intracerebral bleeding sequelae - remained independently associated after adjustment for NIHSS, age and premorbid cognitive dysfunction. Conflict of interest Anne-Lotte Lison: nothing to disclose. Robin Gens: nothing to disclose. Frans Van den Bergh: nothing to disclose. Anne-Marie Van Binst: nothing to disclose. Fran Capitaine: nothing to disclose. Mirte Stiers: nothing to disclose. Yacine Boudiba: nothing to disclose. Anissa Ourtani: nothing to disclose. Fenne Vandervorst: nothing to disclose. Sylvie De Raedt: nothing to disclose. Table 1 - belongs to Results