Department of Rehabilitation and Aged Care, "Fondazione Camplani" Hospital, Cremona, Italy; Geriatric Research Group, Italy.
Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, IRCCS Foundation S Lucia, Roma, Italy.
Am J Geriatr Psychiatry. 2017 Oct;25(10):1064-1071. doi: 10.1016/j.jagp.2017.05.003. Epub 2017 May 4.
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.
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.
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).
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.
迄今为止，人们对谵妄的运动亚型的评估一直局限于单中心研究，对谵妄的易患因素与运动特征之间的关系也仅做了有限的考察。我们旨在报告多中心研究中谵妄亚型的患病率和临床特征。
这是一项巢式病例时点研究，嵌套于“2015 年谵妄日”研究中，该研究纳入了意大利的 108 个急性病房和 12 个康复病房。使用 4-AT 检测谵妄，使用 Delirium Motor Subtype Scale（DMSS）测量运动亚型。使用多项逻辑回归确定与谵妄亚型相关的因素。
在 429 例患有谵妄的患者中，完成了 DMSS 评估的有 275 例（64%），将 21.5%的患者归类为活跃型谵妄，38.5%为不活跃型，27.3%为混合性，12.7%为非运动型。活跃型亚型的 4-AT 评分较高，不活跃型和混合性亚型相似，而非运动型亚型的评分最低。痴呆与所有三种谵妄运动亚型均相关（活跃型，OR 3.3，95%CI：1.2-8.7；不活跃型，OR 2.8，95%CI：1.2-6.5；混合性，OR 2.6，95%CI：1.1-6.2）。非典型抗精神病药与不活跃型谵妄相关（OR 0.23，95%CI：0.1-0.7），而静脉输液与混合性谵妄相关（OR 2.9，95%CI：1.2-6.9）。
该研究表明，不活跃型谵妄是住院老年患者中最常见的亚型。特定的临床特征与不同的谵妄亚型相关。使用标准化工具可以帮助描述不同运动型谵妄亚型的现象学特征。
