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.
Keywords
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