title: Development of an abbreviated version of the delirium motor subtyping scale (DMSS-4).
abstract: BACKGROUND
  Delirium is a common neuropsychiatric syndrome with considerable heterogeneity in clinical profile. Identification of clinical subtypes can allow for more targeted clinical and research efforts. We sought to develop a brief method for clinical subtyping in clinical and research settings.
  
  
  METHODS
  A multi-site database, including motor symptom assessments conducted in 487 patients from palliative care, adult and old age consultation-liaison psychiatry services was used to document motor activity disturbances as per the Delirium Motor Checklist (DMC). Latent class analysis (LCA) was used to identify the class structure underpinning DMC data and also items for a brief subtyping scale. The concordance of the abbreviated scale was then compared with the original Delirium Motor Subtype Scale (DMSS) in 375 patients having delirium as per the American Psychiatric Association's Diagnostic and Statistical Manual (4th edition) criteria.
  
  
  RESULTS
  Latent class analysis identified four classes that corresponded closely with the four recognized motor subtypes of delirium. Further, LCA of items (n = 15) that loaded >60% to the model identified four features that reliably identified the classes/subtypes, and these were combined as a brief motor subtyping scale (DMSS-4). There was good concordance for subtype attribution between the original DMSS and the DMSS-4 (κ = 0.63).
  
  
  CONCLUSIONS
  The DMSS-4 allows for rapid assessment of clinical subtypes in delirium and has high concordance with the longer and well-validated DMSS. More consistent clinical subtyping in delirium can facilitate better delirium management and more focused research effort.
authors.affiliation: University of Limerick Medical School, Limerick, Ireland.
authors.forename: D
authors.initials: D
authors.lastname: Meagher
authors.affiliation: Research and Academic Institute of Athens, Athens, Greece.
authors.forename: D
authors.initials: D
authors.lastname: Adamis
authors.affiliation: University of Limerick Medical School, Limerick, Ireland.
authors.forename: M
authors.initials: M
authors.lastname: Leonard
authors.affiliation: Lilly Research Laboratories, Indianapolis, Indiana, USA.
authors.forename: P
authors.initials: P
authors.lastname: Trzepacz
authors.affiliation: Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
authors.forename: S
authors.initials: S
authors.lastname: Grover
authors.affiliation: Psychiatry for Later Life Service, University College Hospital, Galway, Ireland.
authors.forename: F
authors.initials: F
authors.lastname: Jabbar
authors.affiliation: Psychiatry for Later Life Service, University College Hospital, Galway, Ireland.
authors.forename: K
authors.initials: K
authors.lastname: Meehan
authors.affiliation: University of Limerick Medical School, Limerick, Ireland.
authors.forename: M
authors.initials: M
authors.lastname: O'Connor
authors.affiliation: University of Limerick Medical School, Limerick, Ireland.
authors.forename: C
authors.initials: C
authors.lastname: Cronin
authors.affiliation: University of Limerick Medical School, Limerick, Ireland.
authors.forename: P
authors.initials: P
authors.lastname: Reynolds
authors.affiliation: University of Limerick Medical School, Limerick, Ireland.
authors.forename: J
authors.initials: J
authors.lastname: Fitzgerald
authors.affiliation: Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland.
authors.forename: N
authors.initials: N
authors.lastname: O'Regan
authors.affiliation: Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland.
authors.forename: S
authors.initials: S
authors.lastname: Timmons
authors.affiliation: Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, the Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Slor
authors.affiliation: Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, the Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: de Jonghe
authors.affiliation: Department of Internal Medicine, Geriatrics Section, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: de Jonghe
authors.affiliation: Department of Internal Medicine, Geriatrics Section, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: B C
authors.initials: BC
authors.lastname: van Munster
authors.affiliation: Department of Internal Medicine, Geriatrics Section, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: S E
authors.initials: SE
authors.lastname: de Rooij
authors.affiliation: Edinburgh Delirium Research Group, Geriatric Medicine, Division of Health Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, Scotland, UK.
authors.forename: A
authors.initials: A
authors.lastname: Maclullich
mesh_terms: D000368:Aged; D003693:Delirium / Q000145:classification* / Q000175:diagnosis; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D011569:Psychiatric Status Rating Scales; D011596:Psychomotor Disorders / Q000175:diagnosis* / Q000523:psychology; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index