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Concordance between the delirium motor subtyping scale (DMSS) and the abbreviated version (DMSS-4) over longitudinal assessment in elderly medical inpatients

Published online by Cambridge University Press:  26 November 2015

James Fitzgerald
Affiliation:
Graduate-entry Medical School, University of Limerick, Limerick, Ireland Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Ireland
Niamh O’Regan
Affiliation:
Centre for Gerontology and Rehabilitation, St. Finbarr's Hospital, Cork, Ireland
Dimitrios Adamis
Affiliation:
Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Ireland Sligo-Leitrim Mental Health Services, Manorhamilton Road, Sligo, Ireland
Suzanne Timmons
Affiliation:
Centre for Gerontology and Rehabilitation, St. Finbarr's Hospital, Cork, Ireland
Colum Dunne
Affiliation:
Graduate-entry Medical School, University of Limerick, Limerick, Ireland Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Ireland
Paula Trzepacz
Affiliation:
Indiana University School of Medicine, Indianapolis, Indiana, USA Lilly Research Laboratories, Indianapolis, Indiana, USA University of Mississippi Medical School, Jackson, Mississippi, USA Tufts University School of Medicine, Boston, Massachusetts, USA
David Meagher*
Affiliation:
Graduate-entry Medical School, University of Limerick, Limerick, Ireland Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Ireland Department of Psychiatry, University Hospital Limerick, Limerick, Ireland
*
Correspondence should be addressed to: Professor David Meagher, Graduate-Entry Medical School, University of Limerick, Ireland. Phone: 00353-61-202700. Email: david.meagher@ul.ie.

Abstract

Background:

Delirium is a common neuropsychiatric syndrome that includes clinical subtypes identified by the Delirium Motor Subtyping Scale (DMSS). We explored the concordance between the DMSS and an abbreviated 4-item version in elderly medical inpatients.

Methods:

Elderly general medical admissions (n = 145) were assessed for delirium using the Revised Delirium Rating scale (DRS-R98). Clinical subtype was assessed with the DMSS (which includes the four items included in the DMSS-4). Motor subtypes were generated for all patient assessments using both versions of the scale. The concordance of the original and abbreviated DMSS was examined.

Results:

The agreement between the DMSS and DMSS-4 was high, both at initial and subsequent assessments (κ range 0.75–0.91). Intraclass Correlation Coefficient (ICC) for all three raters for the DMSS was high (0.70) and for DMSS-4 was moderate (0.59). Analysis of the agreement between raters for individual DMSS items found higher concordance in respect of hypoactive features compared to hyperactive.

Conclusions:

The DMSS-4 allows for rapid assessment of clinical subtype in delirium and has high concordance with the longer and well-validated DMSS, including over longitudinal assessment. There is good inter-rater reliability between medical and nursing staff. More consistent clinical subtyping can facilitate better delirium management and more focused research effort.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2015 

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