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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
...Show all authors
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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References

Blazer, D. G. and van Nieuwenhuizenbut, A. O. (2012). Evidence for the diagnostic criteria of delirium: an update. Current Opinion in Psychiatry, 25, 239–243.Google Scholar
de Rooij, S. E. et al. (2006). Delirium subtype identification and the validation of the Delirium Rating Scale – Revised-98 (Dutch version) in hospitalized elderly patients. International Journal of Geriatric Psychiatry, 21, 876–882.Google Scholar
Godfrey, A., Conway, R., Leonard, M., Meagher, D. and O’Laighin, G. M. (2008). Motion analysis in delirium: a wavelet based approach for sub-classification. Conference Proceedings of the IEEE Engineering Medical and Biological Society, 8, 3574–3577.Google Scholar
Godfrey, A., Leonard, M., Donnelly, S., Conroy, M., O’laighin, G. and Meagher, D. (2010). Validating a new clinical subtyping scheme for delirium with electronic motion analysis. Psychiatry Research, 178, 186–190.Google Scholar
Grover, S. et al. (2013). Replication analysis for composition of the Delirium Motor Subtype Scale (DMSS) in a referral cohort from Northern India. Psychiatry Research, 206, 68–74.Google Scholar
Hui, D., Reddy, A., Palla, S. and Bruera, E. (2011). Neuroleptic prescription pattern for delirium in patients with advanced cancer. Journal of Palliative Care, 27, 141–147.Google Scholar
Jabbar, F. et al. (2011). Neuropsychiatric and cognitive profile of patients with DSM-IV delirium referred to an old age psychiatry consultation–liaison service. International Psychogeriatrics, 23, 1167–1174.Google Scholar
Leonard, M., Conroy, M., Donnelly, S., Trzepacz, P. and Meagher, D. (2011). Phenomenological and neuropsychological profile across motor variants in delirium in a palliative care unit. Journal of Neuropsychiatry and Clinical Neurosciences, 23, 180–188.CrossRefGoogle Scholar
Lipowski, Z. J. (1983). Transient cognitive disorder in the elderly. American Journal of Psychiatry, 140, 1426–1436.Google Scholar
Lipowski, Z. J. (1989). Delirium in the elderly patient. New England Journal of Medicine, 320, 578–582.Google Scholar
Liptzin, B. and Levkoff, S. E. (1992). An empirical study of delirium subtypes. British Journal of Psychiatry, 161, 843–845.Google Scholar
MacSweeney, R. et al. (2010). A national survey of the management of delirium in UK intensive care units. Quarterly Journal of Medicine, 103, 243–251.Google Scholar
Mattoo, S. K., Grover, S., Chakravarty, G., Trzepacz, P. T., Gupta, N. and Meagher, D. (2012). Symptom profile and etiology of delirium in a referral population in Northern India: factor analysis of the DRS-R98. Journal of Neuropsychiatry and Clinical Neurosciences, 24, 95–101.Google Scholar
McCutcheon, A. L. (1987). Latent Class Analysis. Thousand Oaks, CA: Sage.CrossRefGoogle Scholar
Meagher, D. (2009). Motor subtypes of delirium: past, present, and future. International Review of Psychiatry, 21, 59–73.Google Scholar
Meagher, D. J. et al. (2007). Phenomenology of delirium. Assessment of 100 adult cases using standardised measures. British Journal of Psychiatry, 190, 135–141.Google Scholar
Meagher, D. J. et al. (2008a). Motor symptoms in 100 patients with delirium versus control subjects: comparison of subtyping methods. Psychosomatics, 49, 300–308.Google Scholar
Meagher, D. et al. (2008b). A new data-based motor subtype schema for delirium. Journal of Neuropsychiatry and Clinical Neurosciences, 20, 185–193.Google Scholar
Meagher, D. J., Leonard, M., Donnelly, S., Conroy, M., Adamis, D. and Trzepacz, P. T. (2011). A longitudinal study of motor subtypes in delirium: relationship with other phenomenology, etiology, medication exposure and prognosis. Journal of Psychosomatic Research, 71, 395–403.Google Scholar
Meagher, D. J., Leonard, M., Donnelly, S., Conroy, M., Adamis, D. and Trzepacz, P. T. (2012). A longitudinal study of motor subtypes in delirium: frequency and stability during episodes. Journal of Psychosomatic Research, 72, 236–241.Google Scholar
Meagher, D. J., McLoughlin, L., Leonard, M., Hannon, N., Dunne, C. and O’Regan, N. (2013). What do we really know about the treatment of delirium with antipsychotics? Ten key issues for delirium pharmacotherapy. American Journal of Geriatric Psychiatry, 21, 1223–1238.Google Scholar
O’Keeffe, S. T. and Lavan, J. N. (1999). Clinical significance of delirium subtypes in older people. Age Ageing, 28, 115–119.Google Scholar
Peterson, J. F. et al. (2006). Delirium and its motoric subtypes: a study of 614 critically ill patients. Journal of American Geriatrics Society, 54, 479–484.Google Scholar
Trzepacz, P. T., Mittal, D., Torres, R., Kanary, K., Norton, J. and Jimerson, N. (2001). Validation of the Delirium Rating Scale – Revised-98 (DRS-R-98). Journal of Neuropsychiatry and Clinical Neurosciences, 13, 229–242.CrossRefGoogle Scholar
Trzepacz, P.T., Meagher, D. and Leonard, M. (2010). Delirium. In Levenson, J. (ed.), Textbook of Psychosomatic Medicine (pp. 71–114). Washington, DC: American Psychiatric Press.Google Scholar
Van Uitert, M., de Jonghe, A., de Gijsel, S., van Someren, E. J., de Rooij, S.E. and van Munster, B. C. (2011). Rest-activity patterns in patients with delirium. Rejuvenation Research, 14, 483–490.Google Scholar
Viera, A. J. and Garrett, J. M. (2005). Understanding the intraobserver agreement: the Kappa statistic. Family Medicine, 37, 360–363.Google Scholar
World Medical Association. (2004). Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. Available at: http://www.wma.net/e/policy/pdf/17c.pdf; last accessed 17 March 2012.Google Scholar
Yang, F. M. et al. (2009). Phenomenological subtypes of delirium in older persons: patterns, prevalence, and prognosis. Psychosomatics, 50, 248–254.Google Scholar