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Psychometric evaluation of the DMSS-4 in a cohort of elderly post-operative hip fracture patients with delirium

Published online by Cambridge University Press:  05 February 2016

Dimitrios Adamis ,
Rikie M. Scholtens ,
Annemarieke de Jonghe ,
Barbara C. van Munster ,
Sophia E.J.A. de Rooij  and
David J. Meagher
Dimitrios Adamis
Affiliation:
Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland Sligo Mental Health Services, Ballytivnan, Sligo, Ireland
Rikie M. Scholtens*
Affiliation:
Department of Internal Medicine, Geriatrics Section, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Annemarieke de Jonghe
Affiliation:
Department of Geriatrics, Tergooi Hospitals, Hilversum and Blaricum, The Netherlands
Barbara C. van Munster
Affiliation:
University Center for Geriatric Medicine, University Medical Center Groningen, Groningen, The Netherlands Department of Geriatrics, Gelre Hospitals, Apeldoorn, The Netherlands
Sophia E.J.A. de Rooij
Affiliation:
University Center for Geriatric Medicine, University Medical Center Groningen, Groningen, The Netherlands
David J. Meagher
Affiliation:
Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland Department of Psychiatry, University Hospital Limerick, Limerick, Ireland
*
Correspondence should be addressed to: Rikie Scholtens, Academic Medical Center, University of Amsterdam, Department of Internal Medicine, Geriatrics section, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands. Phone: +31 20 5661647; Fax: +31 20 5669325. E-mail: [email protected].
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Abstract

Background:

Delirium is a common neuropsychiatric syndrome with considerable heterogeneity in clinical profile. Rapid reliable identification of clinical subtypes can allow for more targeted research efforts.

Methods:

We explored the concordance in attribution of motor subtypes between the Delirium Motor Subtyping Scale 4 (DMSS-4) and the original Delirium Motor Subtyping Scale (DMSS) (assessed cross-sectionally) and subtypes defined longitudinally using the Delirium Symptom Interview (DSI).

Results:

We included 113 elderly patients developing DSM-IV delirium after hip-surgery [mean age 86.9 ± 6.6 years; range 65–102; 68.1% females; 25 (22.1%) had no previous history of cognitive impairment]. Concordance for the first measurement was high for both the DMSS-4 and original DMSS (k = 0.82), and overall for the DMSS-4 and DSI (k = 0.84). The DMSS-4 also demonstrated high internal consistency (McDonald's omega = 0.90). The DSI more often allocated an assessment to “no subtype” compared to the DMSS-4 and DMSS-11, which showed higher inclusion rates for motor subtypes.

Conclusions:

The DMSS-4 provides a rapid method of identifying motor-defined clinical subtypes of delirium and appears to be a reliable alternative to the more detailed and time-consuming original DMSS and DSI methods of subtype attribution. The DMSS-4, so far translated into three languages, can be readily applied to further studies of causation, treatment and outcome in delirium.

Keywords

DeliriumactivitymotorsubtypesphenomenologyassessmentDMSS
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 7 , July 2016 , pp. 1221 - 1228
Copyright
Copyright © International Psychogeriatric Association 2016 

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References

Albert, M. S. et al. (1992). The delirium symptom interview: an interview for the detection of delirium symptoms in hospitalized patients. Journal of Geriatric Psychiatry and Neurology, 5, 14–21.CrossRefGoogle ScholarPubMed
American Psychiatric Association (ed.) 1994. Diagnostic and Statistical Manual of Mental Disorders, Washington, DC, USA: American Psychiatric Press.Google Scholar
de Jonghe, A. et al. (2014). Effect of melatonin on incidence of delirium among patients with hip fracture: a multicentre, double-blind randomized controlled trial. CMAJ : Canadian Medical Association Journal = Journal de l'Association Medicale Canadienne, 186, E547–56.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, 876–82.Google Scholar
de Rooij, S. E., Schuurmans, M. J., van der Mast, R. C. and Levi, M. (2005). Clinical subtypes of delirium and their relevance for daily clinical practice: a systematic review. International Journal of Geriatric Psychiatry, 20, 609–15.Google Scholar
Fitzgerald, J. et al. (2015). Concordance between the delirium motor subtyping scale (DMSS) and the abbreviated version (DMSS-4) over longitudinal assessment in elderly medical inpatients. International Psychogeriatrics/IPA, Epub ahead of print. doi:10.1017/S104161021500191X.Google Scholar
Godfrey, A., Leonard, M., Donnelly, S., Conroy, M., Olaighin, G. and Meagher, D. (2010). Validating a new clinical subtyping scheme for delirium with electronic motion analysis. Psychiatry Research, 178, 186–90.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
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/IPA, 23, 1167–74.Google Scholar
Jorm, A. F. (2004). The informant questionnaire on cognitive decline in the elderly (IQCODE): a review. International Psychogeriatrics/IPA, 16, 275–93.Google Scholar
Laudon, M. and Frydman-Marom, A. (2014). Therapeutic effects of melatonin receptor agonists on sleep and comorbid disorders. International Journal of Molecular Sciences, 15, 15924–50.Google Scholar
Leonard, M., Donnelly, S., Conroy, M., Trzepacz, P. and Meagher, D. J. (2011). Phenomenological and neuropsychological profile across motor variants of delirium in a palliative-care unit. The Journal of Neuropsychiatry and Clinical Neurosciences, 23, 180–8.Google Scholar
Lipowski, Z. J. (1983). Transient cognitive disorders (delirium, acute confusional states) in the elderly. The American Journal of Psychiatry, 140, 1426–36.Google ScholarPubMed
Lipowski, Z. J. (1989). Delirium in the elderly patient. The New England Journal of Medicine, 320, 578–82.Google Scholar
Liptzin, B. and Levkoff, S. E. (1992). An empirical study of delirium subtypes. The British Journal of Psychiatry: The Journal of Mental Science, 161, 843–5.CrossRefGoogle ScholarPubMed
Marcantonio, E., Ta, T., Duthie, E. and Resnick, N. M. (2002). Delirium severity and psychomotor types: their relationship with outcomes after hip fracture repair. Journal of the American Geriatrics Society, 50, 850–7.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, 236–41.Google Scholar
Meagher, D. et al. (2008a). A new data-based motor subtype schema for delirium. The Journal of Neuropsychiatry and Clinical Neurosciences, 20, 185–93.Google Scholar
Meagher, D. J. et al. (2008b). Motor symptoms in 100 patients with delirium versus control subjects: comparison of subtyping methods. Psychosomatics, 49, 300–8.Google Scholar
Meagher, D. (2009). Motor subtypes of delirium: past, present and future. International Review of Psychiatry, 21, 59–73.Google Scholar
Meagher, D. et al. (2014). Development of an abbreviated version of the delirium motor subtyping scale (DMSS-4). International Psychogeriatrics/IPA, 26, 693–702.Google Scholar
O'Keeffe, S. T. and Lavan, J. N. (1999). Clinical significance of delirium subtypes in older people. Age and Ageing, 28, 115–9.CrossRefGoogle ScholarPubMed
Platt, M. M., Breitbart, W., Smith, M., Marotta, R., Weisman, H. and Jacobsen, P. B. (1994). Efficacy of neuroleptics for hypoactive delirium. The Journal of Neuropsychiatry and Clinical Neurosciences, 6, 66–7.Google ScholarPubMed
Radtke, F. M. et al. (2010). A comparison of three scores to screen for delirium on the surgical ward. World Journal of Surgery, 34, 487–94.Google Scholar
Revelle, W. and Zinbarg, R. E. (2009). Coefficients Alpha, Beta, Omega, and the glb: Comments on Sijtsma. Psychometrika, 74, 145–154.Google Scholar
Robinson, T. N., Raeburn, C. D., Tran, Z. V., Brenner, L. A. and Moss, M. (2011). Motor subtypes of postoperative delirium in older adults. Archives of Surgery, 146, 295–300.Google Scholar
Schuurmans, M. J., Shortridge-Baggett, L. M. and Duursma, S. A. (2003). The Delirium observation screening scale: a screening instrument for delirium. Research and Theory for Nursing Practice, 17, 31–50.Google Scholar
Slor, C. J. et al. (2014). Validation and psychometric properties of the Delirium motor subtype scale in elderly hip fracture patients (Dutch version). Archives of Gerontology and Geriatrics, 58, 140–4.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: comparison with the delirium rating scale and the cognitive test for delirium. The Journal of Neuropsychiatry and Clinical Neurosciences, 13, 229–42.Google Scholar