Clinical Features Associated with Delirium Motor Subtypes in Older Inpatients

Results of a Multicenter Study

Alessandro Morandi, Simona Di Santo, Antonio Cherubini, Enrico Mossello, David Meagher, Andrea Mazzone, Angelo Bianchetti, Nicola Ferrara, Alberto Ferrari, Massimo Musicco, Marco Trabucchi, Giuseppe Bellelli, Stefano Boffelli, Fabio Di Stefano, Francesco De Filippi, Fabio Guerini, Erik Bertoletti, Albert March, Alessandro Margiotta, Patrizia Mecocci & 32 others Desireè Addesi, Fausto Fantò, Gianluca Isaia, Babette Dijik, Paola Porrino, Antonino Maria Cotroneo, Giovanni Galli, Amalia Cecilia Bruni, Bruno Bernardini, Carla Corsini, Annachiara Cagnin, Amedeo Zurlo, Giuseppe Barbagallo, Maria Lia Lunardelli, Emilio Martini, Giuseppe Battaglia, Raffaele Latella, Donatella Petritola, Elena Sinforiani, Chiara Mussi, Daniela Mari, Patrizio Odetti, Fiammetta Monacelli, Elio Scarpini, Giuseppina Dell'Aquila, Stefano Avanzi, Simona Di Santo, Antonio Cherubini, Nicola Ferrara, Massimo Musicco, ISGoD Group, ISGoD Group

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objective To date motor subtypes of delirium have been evaluated in single-center studies with a limited examination of the relationship between predisposing factors and motor profile of delirium. We sought to report the prevalence and clinical profile of subtypes of delirium in a multicenter study. Methods This is a point prevalence study nested in the “Delirium Day 2015”, which included 108 acute and 12 rehabilitation wards in Italy. Delirium was detected using the 4-AT and motor subtypes were measured with the Delirium Motor Subtype Scale (DMSS). A multinomial logistic regression was used to determine the factors associated with delirium subtypes. Results Of 429 patients with delirium, the DMSS was completed in 275 (64%), classifying 21.5% of the patients with hyperactive delirium, 38.5% with hypoactive, 27.3% with mixed and 12.7% with the non-motor subtype. The 4-AT score was higher in the hyperactive subtype, similar in the hypoactive, mixed subtypes, while it was lowest in the non-motor subtype. Dementia was associated with all three delirium motor subtypes (hyperactive, OR 3.3, 95% CI: 1.2-8.7; hypoactive, OR 2.8, 95% CI: 1.2-6.5; mixed OR 2.6, 95% CI: 1.1-6.2). Atypical antipsychotics were associated with hypoactive delirium (OR 0.23, 95% CI: 0.1-0.7), while intravenous lines were associated with mixed delirium (OR 2.9, 95% CI: 1.2-6.9). Conclusions The study shows that hypoactive delirium is the most common subtype among hospitalized older patients. Specific clinical features were associated with different delirium subtypes. The use of standardized instruments can help to characterize the phenomenology of different motor subtypes of delirium.

Original languageEnglish
Pages (from-to)1064-1071
Number of pages8
JournalAmerican Journal of Geriatric Psychiatry
Volume25
Issue number10
DOIs
Publication statusPublished - Oct 1 2017

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Delirium
Multicenter Studies
Inpatients
Causality

Keywords

  • 4AT
  • delirium
  • DMSS
  • Motor subtypes of delirium

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Psychiatry and Mental health

Cite this

Clinical Features Associated with Delirium Motor Subtypes in Older Inpatients : Results of a Multicenter Study. / Morandi, Alessandro; Di Santo, Simona; Cherubini, Antonio; Mossello, Enrico; Meagher, David; Mazzone, Andrea; Bianchetti, Angelo; Ferrara, Nicola; Ferrari, Alberto; Musicco, Massimo; Trabucchi, Marco; Bellelli, Giuseppe; Boffelli, Stefano; Di Stefano, Fabio; De Filippi, Francesco; Guerini, Fabio; Bertoletti, Erik; March, Albert; Margiotta, Alessandro; Mecocci, Patrizia; Addesi, Desireè; Fantò, Fausto; Isaia, Gianluca; Dijik, Babette; Porrino, Paola; Cotroneo, Antonino Maria; Galli, Giovanni; Bruni, Amalia Cecilia; Bernardini, Bruno; Corsini, Carla; Cagnin, Annachiara; Zurlo, Amedeo; Barbagallo, Giuseppe; Lunardelli, Maria Lia; Martini, Emilio; Battaglia, Giuseppe; Latella, Raffaele; Petritola, Donatella; Sinforiani, Elena; Mussi, Chiara; Mari, Daniela; Odetti, Patrizio; Monacelli, Fiammetta; Scarpini, Elio; Dell'Aquila, Giuseppina; Avanzi, Stefano; Di Santo, Simona; Cherubini, Antonio; Ferrara, Nicola; Musicco, Massimo; ISGoD Group; ISGoD Group.

In: American Journal of Geriatric Psychiatry, Vol. 25, No. 10, 01.10.2017, p. 1064-1071.

Research output: Contribution to journalArticle

Morandi, A, Di Santo, S, Cherubini, A, Mossello, E, Meagher, D, Mazzone, A, Bianchetti, A, Ferrara, N, Ferrari, A, Musicco, M, Trabucchi, M, Bellelli, G, Boffelli, S, Di Stefano, F, De Filippi, F, Guerini, F, Bertoletti, E, March, A, Margiotta, A, Mecocci, P, Addesi, D, Fantò, F, Isaia, G, Dijik, B, Porrino, P, Cotroneo, AM, Galli, G, Bruni, AC, Bernardini, B, Corsini, C, Cagnin, A, Zurlo, A, Barbagallo, G, Lunardelli, ML, Martini, E, Battaglia, G, Latella, R, Petritola, D, Sinforiani, E, Mussi, C, Mari, D, Odetti, P, Monacelli, F, Scarpini, E, Dell'Aquila, G, Avanzi, S, Di Santo, S, Cherubini, A, Ferrara, N, Musicco, M, ISGoD Group & ISGoD Group 2017, 'Clinical Features Associated with Delirium Motor Subtypes in Older Inpatients: Results of a Multicenter Study', American Journal of Geriatric Psychiatry, vol. 25, no. 10, pp. 1064-1071. https://doi.org/10.1016/j.jagp.2017.05.003
Morandi, Alessandro ; Di Santo, Simona ; Cherubini, Antonio ; Mossello, Enrico ; Meagher, David ; Mazzone, Andrea ; Bianchetti, Angelo ; Ferrara, Nicola ; Ferrari, Alberto ; Musicco, Massimo ; Trabucchi, Marco ; Bellelli, Giuseppe ; Boffelli, Stefano ; Di Stefano, Fabio ; De Filippi, Francesco ; Guerini, Fabio ; Bertoletti, Erik ; March, Albert ; Margiotta, Alessandro ; Mecocci, Patrizia ; Addesi, Desireè ; Fantò, Fausto ; Isaia, Gianluca ; Dijik, Babette ; Porrino, Paola ; Cotroneo, Antonino Maria ; Galli, Giovanni ; Bruni, Amalia Cecilia ; Bernardini, Bruno ; Corsini, Carla ; Cagnin, Annachiara ; Zurlo, Amedeo ; Barbagallo, Giuseppe ; Lunardelli, Maria Lia ; Martini, Emilio ; Battaglia, Giuseppe ; Latella, Raffaele ; Petritola, Donatella ; Sinforiani, Elena ; Mussi, Chiara ; Mari, Daniela ; Odetti, Patrizio ; Monacelli, Fiammetta ; Scarpini, Elio ; Dell'Aquila, Giuseppina ; Avanzi, Stefano ; Di Santo, Simona ; Cherubini, Antonio ; Ferrara, Nicola ; Musicco, Massimo ; ISGoD Group ; ISGoD Group. / Clinical Features Associated with Delirium Motor Subtypes in Older Inpatients : Results of a Multicenter Study. In: American Journal of Geriatric Psychiatry. 2017 ; Vol. 25, No. 10. pp. 1064-1071.
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TY - JOUR

T1 - Clinical Features Associated with Delirium Motor Subtypes in Older Inpatients

T2 - Results of a Multicenter Study

AU - Morandi, Alessandro

AU - Di Santo, Simona

AU - Cherubini, Antonio

AU - Mossello, Enrico

AU - Meagher, David

AU - Mazzone, Andrea

AU - Bianchetti, Angelo

AU - Ferrara, Nicola

AU - Ferrari, Alberto

AU - Musicco, Massimo

AU - Trabucchi, Marco

AU - Bellelli, Giuseppe

AU - Boffelli, Stefano

AU - Di Stefano, Fabio

AU - De Filippi, Francesco

AU - Guerini, Fabio

AU - Bertoletti, Erik

AU - March, Albert

AU - Margiotta, Alessandro

AU - Mecocci, Patrizia

AU - Addesi, Desireè

AU - Fantò, Fausto

AU - Isaia, Gianluca

AU - Dijik, Babette

AU - Porrino, Paola

AU - Cotroneo, Antonino Maria

AU - Galli, Giovanni

AU - Bruni, Amalia Cecilia

AU - Bernardini, Bruno

AU - Corsini, Carla

AU - Cagnin, Annachiara

AU - Zurlo, Amedeo

AU - Barbagallo, Giuseppe

AU - Lunardelli, Maria Lia

AU - Martini, Emilio

AU - Battaglia, Giuseppe

AU - Latella, Raffaele

AU - Petritola, Donatella

AU - Sinforiani, Elena

AU - Mussi, Chiara

AU - Mari, Daniela

AU - Odetti, Patrizio

AU - Monacelli, Fiammetta

AU - Scarpini, Elio

AU - Dell'Aquila, Giuseppina

AU - Avanzi, Stefano

AU - Di Santo, Simona

AU - Cherubini, Antonio

AU - Ferrara, Nicola

AU - Musicco, Massimo

AU - ISGoD Group

AU - ISGoD Group

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Objective To date motor subtypes of delirium have been evaluated in single-center studies with a limited examination of the relationship between predisposing factors and motor profile of delirium. We sought to report the prevalence and clinical profile of subtypes of delirium in a multicenter study. Methods This is a point prevalence study nested in the “Delirium Day 2015”, which included 108 acute and 12 rehabilitation wards in Italy. Delirium was detected using the 4-AT and motor subtypes were measured with the Delirium Motor Subtype Scale (DMSS). A multinomial logistic regression was used to determine the factors associated with delirium subtypes. Results Of 429 patients with delirium, the DMSS was completed in 275 (64%), classifying 21.5% of the patients with hyperactive delirium, 38.5% with hypoactive, 27.3% with mixed and 12.7% with the non-motor subtype. The 4-AT score was higher in the hyperactive subtype, similar in the hypoactive, mixed subtypes, while it was lowest in the non-motor subtype. Dementia was associated with all three delirium motor subtypes (hyperactive, OR 3.3, 95% CI: 1.2-8.7; hypoactive, OR 2.8, 95% CI: 1.2-6.5; mixed OR 2.6, 95% CI: 1.1-6.2). Atypical antipsychotics were associated with hypoactive delirium (OR 0.23, 95% CI: 0.1-0.7), while intravenous lines were associated with mixed delirium (OR 2.9, 95% CI: 1.2-6.9). Conclusions The study shows that hypoactive delirium is the most common subtype among hospitalized older patients. Specific clinical features were associated with different delirium subtypes. The use of standardized instruments can help to characterize the phenomenology of different motor subtypes of delirium.

AB - Objective To date motor subtypes of delirium have been evaluated in single-center studies with a limited examination of the relationship between predisposing factors and motor profile of delirium. We sought to report the prevalence and clinical profile of subtypes of delirium in a multicenter study. Methods This is a point prevalence study nested in the “Delirium Day 2015”, which included 108 acute and 12 rehabilitation wards in Italy. Delirium was detected using the 4-AT and motor subtypes were measured with the Delirium Motor Subtype Scale (DMSS). A multinomial logistic regression was used to determine the factors associated with delirium subtypes. Results Of 429 patients with delirium, the DMSS was completed in 275 (64%), classifying 21.5% of the patients with hyperactive delirium, 38.5% with hypoactive, 27.3% with mixed and 12.7% with the non-motor subtype. The 4-AT score was higher in the hyperactive subtype, similar in the hypoactive, mixed subtypes, while it was lowest in the non-motor subtype. Dementia was associated with all three delirium motor subtypes (hyperactive, OR 3.3, 95% CI: 1.2-8.7; hypoactive, OR 2.8, 95% CI: 1.2-6.5; mixed OR 2.6, 95% CI: 1.1-6.2). Atypical antipsychotics were associated with hypoactive delirium (OR 0.23, 95% CI: 0.1-0.7), while intravenous lines were associated with mixed delirium (OR 2.9, 95% CI: 1.2-6.9). Conclusions The study shows that hypoactive delirium is the most common subtype among hospitalized older patients. Specific clinical features were associated with different delirium subtypes. The use of standardized instruments can help to characterize the phenomenology of different motor subtypes of delirium.

KW - 4AT

KW - delirium

KW - DMSS

KW - Motor subtypes of delirium

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