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

  • Dimitrios Adamis (a1) (a2), Rikie M. Scholtens (a3), Annemarieke de Jonghe (a4), Barbara C. van Munster (a5) (a6), Sophia E.J.A. de Rooij (a5) and David J. Meagher (a1) (a7)...



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.


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).


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.


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.


Corresponding author

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:


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