Hyperactive and hypoactive psychomotor subtypes of delirium in demented and nondemented elderly patients with hip fractures: systematic review and meta-analysis
Article Category: Review article
Published Online: Jan 31, 2017
Page range: 441 - 453
DOI: https://doi.org/10.5372/1905-7415.0904.413
Keywords
© 2015 Sunee Suwanpasu, Youwanuch Sattayasomboon
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
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Study of delirium in elderly patients with and without dementia during hospitalization after hip fracture
| Authors | n | Diagnostic instruments | Prevalence | Outcomes | ||
|---|---|---|---|---|---|---|
| Dementia | Delirium | Delirium | DSD | |||
| de Jonghe et al. 2012 [ | 140 | IQCODE-SF | CAM, | 51% | 81.0% | |
| DOS, DSI | ||||||
| Edelstein et al. 2004 [ | 921 | DSM-IV | DSM-IV | 5.1% | Postop: 30.0% | |
| Edlund et al. 2001 [ | 101 | DSM-IV criteria for organic brain disorders | Modified | 48.5% | Preop: 85.7% | |
| OBS scale | ||||||
| Lee, Ha et al. 2011 [ | 232 | MMSE | CAM | 30.2% | Postop: 70.0% | Prolonged delirium Significant at the 0.05 level (2-tailed). IQCODE = Informant Questionnaire on Cognitive Decline in the Elderly, IQCODE-SF = IQCODE–Short Form, DSM-IV = Diagnostic and Statistical Manual of Mental Disorders IV, CAM = Confusion Assessment Method, DOS = Delirium Observation Screening Scale, DSI = Delirium Symptom Interview, OBS = Organic Brain Syndrome Scale, DSD = Delirium superimposed on dementia, DRS-R-98 = Delirium Rating Scale, Postop = postoperative, Preop = preoperative, BMI = body mass index, QOL = quality of life. |
| Lee, Mears et al. 2011 [ | 425 | MMSE Clinically diagnosed Dementia | CAM | 35.1% | Postop: 54.0% | Risk factors for DSD: |
| Age | ||||||
| Sex | ||||||
| BMI | ||||||
| Comorbidities | ||||||
| Duration of surgery | ||||||
| Lag time from emergency | ||||||
| room to operating room Significant at the 0.05 level (2-tailed). IQCODE = Informant Questionnaire on Cognitive Decline in the Elderly, IQCODE-SF = IQCODE–Short Form, DSM-IV = Diagnostic and Statistical Manual of Mental Disorders IV, CAM = Confusion Assessment Method, DOS = Delirium Observation Screening Scale, DSI = Delirium Symptom Interview, OBS = Organic Brain Syndrome Scale, DSD = Delirium superimposed on dementia, DRS-R-98 = Delirium Rating Scale, Postop = postoperative, Preop = preoperative, BMI = body mass index, QOL = quality of life. | ||||||
| Length of stay | ||||||
| Length of delirium duration Significant at the 0.05 level (2-tailed). IQCODE = Informant Questionnaire on Cognitive Decline in the Elderly, IQCODE-SF = IQCODE–Short Form, DSM-IV = Diagnostic and Statistical Manual of Mental Disorders IV, CAM = Confusion Assessment Method, DOS = Delirium Observation Screening Scale, DSI = Delirium Symptom Interview, OBS = Organic Brain Syndrome Scale, DSD = Delirium superimposed on dementia, DRS-R-98 = Delirium Rating Scale, Postop = postoperative, Preop = preoperative, BMI = body mass index, QOL = quality of life. | ||||||
| Lundström et al. 2012 [ | 199 | Former dementia diagnosis | Modified | 64.8% | Postop: 85.0% | Length of delirium duration |
| OBS | Length of stay | |||||
| Hip luxation Significant at the 0.05 level (2-tailed). IQCODE = Informant Questionnaire on Cognitive Decline in the Elderly, IQCODE-SF = IQCODE–Short Form, DSM-IV = Diagnostic and Statistical Manual of Mental Disorders IV, CAM = Confusion Assessment Method, DOS = Delirium Observation Screening Scale, DSI = Delirium Symptom Interview, OBS = Organic Brain Syndrome Scale, DSD = Delirium superimposed on dementia, DRS-R-98 = Delirium Rating Scale, Postop = postoperative, Preop = preoperative, BMI = body mass index, QOL = quality of life. | ||||||
| Depression | ||||||
| Mortality | ||||||
| Subtypes of delirium Significant at the 0.05 level (2-tailed). IQCODE = Informant Questionnaire on Cognitive Decline in the Elderly, IQCODE-SF = IQCODE–Short Form, DSM-IV = Diagnostic and Statistical Manual of Mental Disorders IV, CAM = Confusion Assessment Method, DOS = Delirium Observation Screening Scale, DSI = Delirium Symptom Interview, OBS = Organic Brain Syndrome Scale, DSD = Delirium superimposed on dementia, DRS-R-98 = Delirium Rating Scale, Postop = postoperative, Preop = preoperative, BMI = body mass index, QOL = quality of life. | ||||||
| Juliebø et al. 2009 [ | 364 | IQCODE-SF | CAM | 32.4% | 46.5% | |
| Preop: 33.3% | ||||||
| Postop: 54.7% | ||||||
| Juliebø et al. 2010 [ | 331 | IQCODE | CAM | 43.2% | 66.9% | Mortality Significant at the 0.05 level (2-tailed). IQCODE = Informant Questionnaire on Cognitive Decline in the Elderly, IQCODE-SF = IQCODE–Short Form, DSM-IV = Diagnostic and Statistical Manual of Mental Disorders IV, CAM = Confusion Assessment Method, DOS = Delirium Observation Screening Scale, DSI = Delirium Symptom Interview, OBS = Organic Brain Syndrome Scale, DSD = Delirium superimposed on dementia, DRS-R-98 = Delirium Rating Scale, Postop = postoperative, Preop = preoperative, BMI = body mass index, QOL = quality of life. |
| Marcantonio et al. 2000 [ | 126 | Blessed Dementia Rating scale | CAM, | 41.0% | Postop: 66.0% | |
| DSI | ||||||
| Marcantonio et al. 2002 [ | 122 | Blessed Dementia Rating scale | CAM | 40.2% | Subtypes of delirium Significant at the 0.05 level (2-tailed). IQCODE = Informant Questionnaire on Cognitive Decline in the Elderly, IQCODE-SF = IQCODE–Short Form, DSM-IV = Diagnostic and Statistical Manual of Mental Disorders IV, CAM = Confusion Assessment Method, DOS = Delirium Observation Screening Scale, DSI = Delirium Symptom Interview, OBS = Organic Brain Syndrome Scale, DSD = Delirium superimposed on dementia, DRS-R-98 = Delirium Rating Scale, Postop = postoperative, Preop = preoperative, BMI = body mass index, QOL = quality of life. | |
| MDAS | Severity of delirium Significant at the 0.05 level (2-tailed). IQCODE = Informant Questionnaire on Cognitive Decline in the Elderly, IQCODE-SF = IQCODE–Short Form, DSM-IV = Diagnostic and Statistical Manual of Mental Disorders IV, CAM = Confusion Assessment Method, DOS = Delirium Observation Screening Scale, DSI = Delirium Symptom Interview, OBS = Organic Brain Syndrome Scale, DSD = Delirium superimposed on dementia, DRS-R-98 = Delirium Rating Scale, Postop = postoperative, Preop = preoperative, BMI = body mass index, QOL = quality of life. | |||||
| Olofsson et al. 2005 [ | 61 | MMSE | The modified | 62.3% | Postop: 80.0% | |
| OBS | ||||||
| Olofsson et al. 2009 [ | 180 | MMSE | OBS | 65.0% | Preop: 50.9% | One year functional ability Significant at the 0.05 level (2-tailed). IQCODE = Informant Questionnaire on Cognitive Decline in the Elderly, IQCODE-SF = IQCODE–Short Form, DSM-IV = Diagnostic and Statistical Manual of Mental Disorders IV, CAM = Confusion Assessment Method, DOS = Delirium Observation Screening Scale, DSI = Delirium Symptom Interview, OBS = Organic Brain Syndrome Scale, DSD = Delirium superimposed on dementia, DRS-R-98 = Delirium Rating Scale, Postop = postoperative, Preop = preoperative, BMI = body mass index, QOL = quality of life. |
| Postop: 83.6% | Depression | |||||
| Mortality | ||||||
| QOL | ||||||
| Slor, Witlox et al. 2013 [ | 157 | MMSE | CAM | 36.3% | 72.6% | Length of delirium duration Significant at the 0.05 level (2-tailed). IQCODE = Informant Questionnaire on Cognitive Decline in the Elderly, IQCODE-SF = IQCODE–Short Form, DSM-IV = Diagnostic and Statistical Manual of Mental Disorders IV, CAM = Confusion Assessment Method, DOS = Delirium Observation Screening Scale, DSI = Delirium Symptom Interview, OBS = Organic Brain Syndrome Scale, DSD = Delirium superimposed on dementia, DRS-R-98 = Delirium Rating Scale, Postop = postoperative, Preop = preoperative, BMI = body mass index, QOL = quality of life. |
| IQCODE | DRS-R-98 | Severity of delirium | ||||
| Slor, Adamis et al. 2013 [ | 169 | MMSE | CAM | 44.4% | Postop: 67.7% | Subtypes of delirium |
| IQCODE | DRS-R-98 | |||||
| Santos et al. 2005 [ | 34 | MMSE | CAM | 54.9% | Postop:81.8% | Length of delirium duration |
| Subtypes of delirium | ||||||
The psychomotor types of delirium in patients with and without dementia
| Motor subtypes of delirium | Delirium superimposed on dementia | Delirium only | ||||
|---|---|---|---|---|---|---|
| Pool OR (95% CI) | Model of meta-analysis | Pool OR (95% CI) | Model of meta-analysis | |||
| Any hyperactive | 2.27 (1.72-4.41) | Fix effect | 0.015 Significant at the 0.05 level (2-tailed); OR = odds ratio | 0.86 (0.48-1.53) | Fix effect | NS |
| Hypoactive | 0.45 (0.23-0.87) | Fix effect | 0.018 Significant at the 0.05 level (2-tailed); OR = odds ratio | 2.22 (1.15-4.27) | Fix effect | 0.018 Significant at the 0.05 level (2-tailed); OR = odds ratio |
PICO (patient, intervention or exposure, comparator, and outcome): eligibility criteria for considering studies for this review
| Population: | Older adults (≥65 years old) with hip fracture; subgroups include those with delirium and/or those with dementia (e.g., dementia, dementia with Lewy bodies, Alzheimer disease) Older adults were consider as living with dementia if Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) score was ≥3.6, IQCODE-Short Form score was ≥3.44, Blessed Dementia Scale score was ≥4, or Mini–Mental State Examination score ≤24 |
| Intervention or exposure: | Delirium superimposed on dementia |
| Comparator group: | Delirium |
| Outcome or endpoint: | Symptom profile, duration and/or severity, length of hospital stay, physical and/or cognitive recovery, mortality |