Skip to main content Accessibility help
×
Home

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)...

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.

Copyright

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: r.m.scholtens@amc.uva.nl.

References

Hide All
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, 1421.
American Psychiatric Association (ed.) 1994. Diagnostic and Statistical Manual of Mental Disorders, Washington, DC, USA: American Psychiatric Press.
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.
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.
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.
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.
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.
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, 6874.
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.
Jorm, A. F. (2004). The informant questionnaire on cognitive decline in the elderly (IQCODE): a review. International Psychogeriatrics/IPA, 16, 275–93.
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.
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.
Lipowski, Z. J. (1983). Transient cognitive disorders (delirium, acute confusional states) in the elderly. The American Journal of Psychiatry, 140, 1426–36.
Lipowski, Z. J. (1989). Delirium in the elderly patient. The New England Journal of Medicine, 320, 578–82.
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.
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.
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, 395403.
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.
Meagher, D. et al. (2008a). A new data-based motor subtype schema for delirium. The Journal of Neuropsychiatry and Clinical Neurosciences, 20, 185–93.
Meagher, D. J. et al. (2008b). Motor symptoms in 100 patients with delirium versus control subjects: comparison of subtyping methods. Psychosomatics, 49, 300–8.
Meagher, D. (2009). Motor subtypes of delirium: past, present and future. International Review of Psychiatry, 21, 5973.
Meagher, D. et al. (2014). Development of an abbreviated version of the delirium motor subtyping scale (DMSS-4). International Psychogeriatrics/IPA, 26, 693702.
O'Keeffe, S. T. and Lavan, J. N. (1999). Clinical significance of delirium subtypes in older people. Age and Ageing, 28, 115–9.
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.
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.
Revelle, W. and Zinbarg, R. E. (2009). Coefficients Alpha, Beta, Omega, and the glb: Comments on Sijtsma. Psychometrika, 74, 145154.
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, 295300.
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, 3150.
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.
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.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed