Clinical Features Associated with Delirium Motor Subtypes in Older Inpatients: Results of a Multicenter Study
Clinical Features Associated with Delirium Motor Subtypes in Older Inpatients: Results of a Multicenter Study
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DOI：
10.1016/j.jagp.2017.05.003
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发表时间：
2017-10-01
影响因子：
7.2
通讯作者：
Bo, Mario
中科院分区：
文献类型：
--
作者：
Morandi, Alessandro;Di Santo, Simona G.;Bo, Mario
目的：迄今为止，在单中心研究中对谵妄的运动亚型进行了评价，对谵妄的诱发因素和运动特征之间的关系进行了有限的检查。我们试图在一项多中心研究中报告谵妄亚型的患病率和临床特征。方法：这是一项嵌套在“2015年谵妄日”中的点患病率研究，包括意大利的108个急性病房和12个康复病房。使用4-AT检测谵妄，并使用谵妄运动亚型量表（DMSS）测量运动亚型。多项逻辑回归用于确定与谵妄亚型相关的因素。结果如下：在429例谵妄患者中，275例（64%）完成了DMSS，其中21.5%的患者被分类为多动症型谵妄，38.5%的患者被分类为多动症型谵妄，27.3%的患者被分类为混合型谵妄，12.7%的患者被分类为非运动亚型。4-AT评分在多动亚型中较高，在少动、混合亚型中相似，而在非运动亚型中最低。痴呆与所有三种谵妄运动亚型相关（多动，OR 3.3，95% CI：1.2-8.7;少动，OR 2.8，95% CI：1.2-6.5;混合OR 2.6，95% CI：1.1-6.2）。非典型抗精神病药物与低活动性谵妄相关（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）。结论：低活动性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。使用标准化的仪器可以帮助描述谵妄不同运动亚型的现象学特征。
Objective: 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. Methods: 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. Results: 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 nonmotor 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). Conclusions: 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.