Department of Rehabilitation and Aged Care, "Fondazione Camplani" Hospital, Cremona, Italy.
School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
J Am Med Dir Assoc. 2020 Apr;21(4):486-492.e7. doi: 10.1016/j.jamda.2020.02.013.
Few studies have analyzed factors associated with delirium subtypes. In this study, we investigate factors associated with subtypes of delirium only in patients with dementia to provide insights on the possible prevention and treatments.
This is a cross-sectional study nested in the "Delirium Day" study, a nationwide Italian point-prevalence study.
Older patients admitted to 205 acute and 92 rehabilitation hospital wards.
Delirium was evaluated with the 4-AT and the motor subtypes with the Delirium Motor Subtype Scale. Dementia was defined by the presence of a documented diagnosis in the medical records and/or prescription of acetylcholinesterase inhibitors or memantine prior to admission.
Of the 1057 patients with dementia, 35% had delirium, with 25.6% hyperactive, 33.1% hypoactive, 34.5% mixed, and 6.7% nonmotor subtype. There were higher odds of having venous catheters in the hypoactive (OR 1.82, 95% CI 1.18-2.81) and mixed type of delirium (OR 2.23, CI 1.43-3.46), whereas higher odds of urinary catheters in the hypoactive (OR 2.91, CI 1.92-4.39), hyperactive (OR 1.99, CI 1.23-3.21), and mixed types of delirium (OR 2.05, CI 1.36-3.07). We found higher odds of antipsychotics both in the hyperactive (OR 2.87, CI 1.81-4.54) and mixed subtype (OR 1.84, CI 1.24-2.75), whereas higher odds of antibiotics was present only in the mixed subtype (OR 1.91, CI 1.26-2.87).
In patients with dementia, the mixed delirium subtype is the most prevalent followed by the hypoactive, hyperactive, and nonmotor subtype. Motor subtypes of delirium may be triggered by clinical factors, including the use of venous and urinary catheters, and the use of antipsychotics. Future studies are necessary to provide further insights on the possible pathophysiology of delirium in patients with dementia and to address the optimization of the management of potential risk factors.
很少有研究分析与谵妄亚型相关的因素。本研究仅在痴呆患者中调查与谵妄亚型相关的因素，以期为可能的预防和治疗提供思路。
这是一项嵌套在“谵妄日”研究中的横断面研究，该研究是一项意大利全国性的时点患病率研究。
205 间急性病房和 92 间康复病房收治的老年患者。
使用 4-AT 评估谵妄，使用谵妄运动亚型量表评估运动亚型。痴呆的定义是病历中有记录的诊断或入院前使用乙酰胆碱酯酶抑制剂或美金刚。
在 1057 例痴呆患者中，35%患有谵妄，其中 25.6%为活跃型，33.1%为不活跃型，34.5%为混合型，6.7%为非运动型。在不活跃型（OR 1.82，95%CI 1.18-2.81）和混合型（OR 2.23，CI 1.43-3.46）谵妄中，静脉导管的发生几率更高，而在不活跃型（OR 2.91，CI 1.92-4.39）、活跃型（OR 1.99，CI 1.23-3.21）和混合型（OR 2.05，CI 1.36-3.07）谵妄中，尿管的发生几率更高。我们发现抗精神病药物在活跃型（OR 2.87，CI 1.81-4.54）和混合亚型（OR 1.84，CI 1.24-2.75）中的使用几率更高，而抗生素仅在混合亚型（OR 1.91，CI 1.26-2.87）中更为常见。
在痴呆患者中，混合性谵妄亚型最为常见，其次是不活跃型、活跃型和非运动型。谵妄的运动亚型可能由包括静脉和导尿管使用以及抗精神病药物使用在内的临床因素引发。未来的研究有必要进一步了解痴呆患者谵妄的可能病理生理学，并解决潜在危险因素管理的优化问题。
