Hospital Psiquiatric Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, Reus, Tarragona, Spain.
Psychosomatics. 2013 May-Jun;54(3):227-38. doi: 10.1016/j.psym.2012.06.010. Epub 2012 Dec 4.
To confirm the existence of the proposed three-core symptom domains in delirium by analyzing a dataset of nondemented adults using selected core symptoms as measured by the Delirium Rating Scale-Revised-98 (DRS-R98) scale.
Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) of proposed delirium core symptoms were conducted in a pooled international dataset of 592 delirious and nondelirious patients using DSM-IV criteria from 14 studies with comparable methodologies. Using DRS-R98 categorization, 445 had either subsyndromal or full delirium and comprised the delirium group. The dataset was divided into three independent random subsamples to perform a stepwise analysis. First we performed EFA in 100 cases to delineate latent factor loadings of DRS-R98 items selected to represent the three-core domains (circadian, higher level thinking, and cognitive). These items were then assessed using CFA-modeling (n = 246) followed by a CFA-validation (n = 246). Reliability and goodness of fit of these two CFA were assessed statistically.
DRS-R98 items representing the proposed delirium core symptoms loaded onto one factor in the EFA, supporting their core nature. The two CFA confirmed the nature of this core factor as comprising three core domains where DRS-R98 items each loaded with high values (>0.7) onto their corresponding core domain (circadian, higher level thinking, and cognitive) with good fit and reliability. Attention was DRS-R98 item with the highest loading in CFA, followed by thought process, and then by sleep-wake cycle and motor behavior.
Our EFA and CFA confirm and validate the proposed three-core domains of delirium, where symptoms were highly related to the domain that they were hypothesized to represent. These domains are consistent with delirium being a state of impaired consciousness, and should be considered necessary to assess whether in clinical or research settings.
通过对使用 Delirium Rating Scale-Revised-98（DRS-R98）量表测量的选定核心症状的非痴呆成人数据集进行分析，确认谵妄拟议的三个核心症状域的存在。
在使用 DSM-IV 标准的来自 14 项具有可比性方法的研究的 592 名谵妄和非谵妄患者的国际合并数据集上，进行了拟议的谵妄核心症状的探索性因子分析（EFA）和验证性因子分析（CFA）。使用 DRS-R98 分类，445 例患者既有亚综合征性也有完全谵妄，构成了谵妄组。数据集被分为三个独立的随机子样本进行逐步分析。首先，我们在 100 例患者中进行了 EFA，以描绘出代表三个核心领域（昼夜节律、高级思维和认知）的 DRS-R98 项目的潜在因子负荷。然后使用 CFA 建模（n = 246）评估这些项目，然后进行 CFA 验证（n = 246）。这两个 CFA 的可靠性和拟合度均进行了统计学评估。
代表拟议的谵妄核心症状的 DRS-R98 项目在 EFA 中加载到一个因子上，支持其核心性质。这两个 CFA 证实了该核心因子的性质，即包含三个核心领域，其中 DRS-R98 项目各自以高值（>0.7）加载到其对应的核心领域（昼夜节律、高级思维和认知），具有良好的拟合度和可靠性。注意力是 CFA 中负荷最高的 DRS-R98 项目，其次是思维过程，然后是睡眠-觉醒周期和运动行为。
我们的 EFA 和 CFA 确认和验证了拟议的谵妄三个核心领域，其中症状与它们假设代表的领域高度相关。这些领域与谵妄作为一种意识障碍状态一致，在临床或研究环境中都应被视为必要的评估内容。
