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

Meagher, David; Adamis, Dimitrios; Leonard, Maeve; Trzepacz, Paula T.; Grover, Sandeep; Jabbar, Faiza; Meehan, Karena; O’Connor, Margaret; Cronin, C.; Reynolds, Paul; Fitzgerald, J M; O’Regan, N; Timmons, Suzanne; Slor, Chantal J.; Jonghe, Jos de; Jonghe, Annemarieke de; Munster, Barbara C. Van; Rooij, Sophia E. de; MacLullich, Alasdair M.J.

doi:10.1017/s1041610213002585

Cited by 55 publications

(45 citation statements)

References 29 publications

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“…This assessment combines objective testing of the participant, lasting approximately ten minutes, with information gained from informants (usually nurses, next of kin and clinical records) and assessor’s judgement regarding subjective features. Along with determining whether delirium is present according to DSM-5, the assessment enables scores to be generated for delirium severity, based upon the Memorial Delirium Assessment Scale [23], and motor subtype, based upon the Delirium Motor Subtype Scale [24]. …”

Section: Methodsmentioning

confidence: 99%

Protocol for the Delirium and Cognitive Impact in Dementia (DECIDE) study: A nested prospective longitudinal cohort study

et al. 2017

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BackgroundDelirium is common, affecting at least 20% of older hospital inpatients. It is widely accepted that delirium is associated with dementia but the degree of causation within this relationship is unclear. Previous studies have been limited by incomplete ascertainment of baseline cognition or a lack of prospective delirium assessments. There is an urgent need for an improved understanding of the relationship between delirium and dementia given that delirium prevention may plausibly impact upon dementia prevention. A well-designed, observational study could also answer fundamental questions of major importance to patients and their families regarding outcomes after delirium.The Delirium and Cognitive Impact in Dementia (DECIDE) study aims to explore the association between delirium and cognitive function over time in older participants. In an existing population based cohort aged 65 years and older, the effect on cognition of an episode of delirium will be measured, independent of baseline cognition and illness severity. The predictive value of clinical parameters including delirium severity, baseline cognition and delirium subtype on cognitive outcomes following an episode of delirium will also be explored.MethodsOver a 12 month period, surviving participants from the Cognitive Function and Ageing Study II-Newcastle will be screened for delirium on admission to hospital. At the point of presentation, baseline characteristics along with a number of disease relevant clinical parameters will be recorded. The progression/resolution of delirium will be monitored. In those with and without delirium, cognitive decline and dementia will be assessed at one year follow-up. We will evaluate the effect of delirium on cognitive function over time along with the predictive value of clinical parameters.DiscussionThis study will be the first to prospectively elucidate the size of the effect of delirium upon cognitive decline and incident dementia. The results will be used to inform future dementia prevention trials that focus on delirium intervention.

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Section: Methodsmentioning

confidence: 99%

Protocol for the Delirium and Cognitive Impact in Dementia (DECIDE) study: A nested prospective longitudinal cohort study

et al. 2017

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“…It is unclear how delirium with normal level of arousal corresponds to each psychomotor subtype. While these patients likely represent delirium with no psychomotor abnormalities, which can occur 24% to 35% of the cases, 16,17 it possible that a significant proportion may have hypoactive, hyperactive, or mixed-type delirium. Further study is needed to investigate the relationship between arousal and the psychomotor subtype and if one method of delirium subtyping is superior to the other with regard to determining prognosis.…”

Section: Discussionmentioning

confidence: 99%

Exploring Delirium's Heterogeneity: Association Between Arousal Subtypes at Initial Presentation and 6-Month Mortality in Older Emergency Department Patients

Han

Brummel

Chandrasekhar

et al. 2017

The American Journal of Geriatric Psychiatry

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Objectives To determine how delirium subtyped by level of arousal at initial presentation affects 6-month mortality. Design This was a preplanned secondary analysis of two prospective cohort studies. Setting Academic tertiary care emergency department (ED). Participants 1,084 ED patients who were 65 years old or older. Measurements At the time of enrollment, trained research personnel performed the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and Richmond Agitation Sedation Scale (RASS) to determine delirium and level of arousal, respectively. Patients were categorized as having no delirium, delirium with normal arousal, delirium with decreased arousal, or delirium with increased arousal. Death was ascertained by medical record review and the Social Security Death Index. Cox proportional hazard regression was used to analyze the association between delirium arousal subtypes and 6-month mortality. Results Delirium with normal arousal was the only subtype that was significantly associated with increased 6-month mortality (HR=3.1, 95%CI: 1.3 – 7.4) compared with the no delirium group after adjusting for confounders. The HRs for delirium with decreased and increased arousal were 1.4 (95%CI: 0.9 – 2.1) and 1.3 (95%CI: 0.3 – 5.4), respectively. Conclusion Delirious ED patients with normal arousal at initial presentation had a three-fold increased hazard of death within 6-months compared to patients without delirium. There was a trend towards increased hazard of death in delirious ED patients with decreased arousal, but this relationship did not reach statistical significance. These data suggest that subtyping delirium by arousal may have prognostic value but requires confirmation with a larger study.

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“…Delirium Motor Checklist (DMC) [31]will be used to assess number of hyper- and hypoactive symptoms. Delirious patients will be divided into hypo-, hyperactive, mixed and no subtype according to criteria from Delirium Motor Subtype Scale 4 [32]. Short, structured questionnaire regarding night and day behavior and cognitive fluctuations will be fulfilled by ward nurses.…”

Section: Methodsmentioning

confidence: 99%

PRospective Observational POLIsh Study on post-stroke delirium (PROPOLIS): methodology of hospital-based cohort study on delirium prevalence, predictors and diagnostic tools

Klimiec

Dziedzic

Kowalska³

et al. 2015

BMC Neurol

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BackgroundBetween 10 % to 48 % of patients develop delirium in acute phase of stroke. Delirium determinants and its association with other neuropsychiatric disturbances in stroke are poorly understood. The wildly accepted predictive model of post-stroke delirium is still lacking.Methods/designThis is a prospective, observational, single-center study in patients with acute phase of stroke. We aim to include 750 patients ≥18 years with acute stroke or transient ischemic attack admitted to the stroke unit within 48 hours after stroke onset. The goals of the study are: 1) to determine frequency of delirium and subsyndromal delirium in Polish stroke patients within 7 days after admission to the hospital; 2) to determine factors associated with incidence, severity and duration of delirium and subsyndromal delirium and to create a predictive model for post-stroke delirium; 3) to determine the association between delirium and its cognitive, psychiatric, behavioral and functional short and long-term consequences; 4) to validate scales used for delirium diagnosis in stroke population.Patients will be screened for delirium on daily basis. The diagnosis of delirium will be based on DSM-V criteria. Abbreviated version of Confusion Assessment Method and Confusion Assessment Method for the Intensive Care Unit will be used for delirium and sub-delirium screening. Severity of delirium symptoms will be assessed by Delirium Rating Scale Revised 98 and Cognitive Test for Delirium. Patients who survive will undergo extensive neuropsychological, neuropsychiatric and functional assessment 3 and 12 months after the stroke.DiscussionThis study is designed to provide information on clinical manifestation, diagnostic methods and determinants of delirium spectrum disorders in acute stroke phase and their short and long-term consequences. Collected information allow us to create a predictive model for post-stroke delirium.

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

Abstract: 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.

Cited by 55 publications

References 29 publications

Protocol for the Delirium and Cognitive Impact in Dementia (DECIDE) study: A nested prospective longitudinal cohort study

Protocol for the Delirium and Cognitive Impact in Dementia (DECIDE) study: A nested prospective longitudinal cohort study

Exploring Delirium's Heterogeneity: Association Between Arousal Subtypes at Initial Presentation and 6-Month Mortality in Older Emergency Department Patients

PRospective Observational POLIsh Study on post-stroke delirium (PROPOLIS): methodology of hospital-based cohort study on delirium prevalence, predictors and diagnostic tools

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