학술논문
Understanding Factors Associated With Psychomotor Subtypes of Delirium in Older Inpatients With Dementia.
Document Type
Academic Journal
Author
Morandi A; Department of Rehabilitation and Aged Care, 'Fondazione Camplani' Hospital, Cremona, Italy. Electronic address: morandi.alessandro@gmail.com.; Zambon A; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.; Di Santo SG; Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, IRCCS Foundation S Lucia, Rome, Italy.; Mazzone A; Redaelli Geriatric Institute, Milan, Italy.; Cherubini A; Geriatria, Accettazione geriatrica, Centro di ricerca per l'invecchiamento, IRCCS-INRCA, Ancona, Italy.; Mossello E; Research Unit of Medicine of Ageing, Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.; Bo M; Section of Geriatrics, Città della Salute e della Scienza-Molinette, Turin, Italy.; Marengoni A; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.; Bellelli G; Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, IRCCS Foundation S Lucia, Rome, Italy; Geriatric Unit, S. Gerardo Hospital, Monza, Italy.
Source
Publisher: Elsevier Country of Publication: United States NLM ID: 100893243 Publication Model: Print Cited Medium: Internet ISSN: 1538-9375 (Electronic) Linking ISSN: 15258610 NLM ISO Abbreviation: J Am Med Dir Assoc Subsets: MEDLINE
Subject
Language
English
Abstract
Objectives: 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.
Design: This is a cross-sectional study nested in the "Delirium Day" study, a nationwide Italian point-prevalence study.
Setting and Participants: Older patients admitted to 205 acute and 92 rehabilitation hospital wards.
Measures: 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.
Results: 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).
Conclusions and Implications: 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.
(Copyright © 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)
Design: This is a cross-sectional study nested in the "Delirium Day" study, a nationwide Italian point-prevalence study.
Setting and Participants: Older patients admitted to 205 acute and 92 rehabilitation hospital wards.
Measures: 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.
Results: 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).
Conclusions and Implications: 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.
(Copyright © 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)