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Development of an abbreviated version of the Delirium Motor Subtyping Scale (DMSS-4)

Published online by Cambridge University Press:  16 January 2014

D. Meagher ,
D. Adamis ,
M. Leonard ,
P. Trzepacz ,
S. Grover ,
F. Jabbar ,
K. Meehan ,
M. O’Connor ,
C. Cronin  and
P. Reynolds
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D. Meagher*
Affiliation:
University of Limerick Medical School, Limerick, Ireland Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Ireland Department of Psychiatry, University Hospital Limerick, Limerick, Ireland
D. Adamis
Affiliation:
Research and Academic Institute of Athens, Athens, Greece Sligo Mental Health Services, Sligo, Ireland
M. Leonard
Affiliation:
University of Limerick Medical School, Limerick, Ireland Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Ireland Department of Psychiatry, University Hospital Limerick, Limerick, Ireland
P. Trzepacz
Affiliation:
Lilly Research Laboratories, Indianapolis, Indiana, USA University of Mississippi Medical School, Jackson, Mississippi, USA Tufts University School of Medicine, Boston, Massachusetts, USA Indiana University School of Medicine, Indianapolis, Indiana, USA
S. Grover
Affiliation:
Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
F. Jabbar
Affiliation:
Psychiatry for Later Life Service, University College Hospital, Galway, Ireland
K. Meehan
Affiliation:
Psychiatry for Later Life Service, University College Hospital, Galway, Ireland
M. O’Connor
Affiliation:
University of Limerick Medical School, Limerick, Ireland Department of Elderly Medicine, Midwestern Regional Hospital, Limerick, Ireland
C. Cronin
Affiliation:
University of Limerick Medical School, Limerick, Ireland Department of Elderly Medicine, Midwestern Regional Hospital, Limerick, Ireland St John's Hospital, Limerick, Ireland
P. Reynolds
Affiliation:
University of Limerick Medical School, Limerick, Ireland Department of Psychiatry, University Hospital Limerick, Limerick, Ireland
J. Fitzgerald
Affiliation:
University of Limerick Medical School, Limerick, Ireland Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Ireland
N. O’Regan
Affiliation:
Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland
S. Timmons
Affiliation:
Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland
C. Slor
Affiliation:
Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, the Netherlands
J. de Jonghe
Affiliation:
Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, the Netherlands
A. de Jonghe
Affiliation:
Department of Internal Medicine, Geriatrics Section, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
B. C. van Munster
Affiliation:
Department of Internal Medicine, Geriatrics Section, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands Department of Geriatrics, Gelre Hospitals, Apeldoorn, the Netherlands
S. E. de Rooij
Affiliation:
Department of Internal Medicine, Geriatrics Section, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
A. Maclullich
Affiliation:
Edinburgh Delirium Research Group, Geriatric Medicine, Division of Health Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, Scotland, UK Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, Scotland, UK
*
Correspondence should be addressed to: Professor David Meagher, University of Limerick School of Medicine, Ireland. Phone: +00353-61-315177. Email: david.meagher@ul.ie.
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Abstract

Background:

Delirium is a common neuropsychiatric syndrome with considerable heterogeneity in clinical profile. Identification of clinical subtypes can allow for more targeted clinical and research efforts. We sought to develop a brief method for clinical subtyping in clinical and research settings.

Methods:

A multi-site database, including motor symptom assessments conducted in 487 patients from palliative care, adult and old age consultation-liaison psychiatry services was used to document motor activity disturbances as per the Delirium Motor Checklist (DMC). Latent class analysis (LCA) was used to identify the class structure underpinning DMC data and also items for a brief subtyping scale. The concordance of the abbreviated scale was then compared with the original Delirium Motor Subtype Scale (DMSS) in 375 patients having delirium as per the American Psychiatric Association's Diagnostic and Statistical Manual (4th edition) criteria.

Results:

Latent class analysis identified four classes that corresponded closely with the four recognized motor subtypes of delirium. Further, LCA of items (n = 15) that loaded >60% to the model identified four features that reliably identified the classes/subtypes, and these were combined as a brief motor subtyping scale (DMSS-4). There was good concordance for subtype attribution between the original DMSS and the DMSS-4 (κ = 0.63).

Conclusions:

The DMSS-4 allows for rapid assessment of clinical subtypes in delirium and has high concordance with the longer and well-validated DMSS. More consistent clinical subtyping in delirium can facilitate better delirium management and more focused research effort.

Keywords

deliriumactivitymotorsubtypesphenomenologyassessment
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 4 , April 2014 , pp. 693 - 702
Copyright
Copyright © International Psychogeriatric Association 2014 

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