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Motor activity across delirium motor subtypes in geriatric patients assessed using body-worn sensors: a Norwegian cross-sectional study
  1. Sigurd Evensen1,2,
  2. Alan Kevin Bourke1,
  3. Stian Lydersen3,
  4. Olav Sletvold1,2,
  5. Ingvild Saltvedt1,
  6. Torgeir Bruun Wyller4,5,
  7. Kristin Taraldsen1
  1. 1 Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
  2. 2 Department of Geriatrics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
  3. 3 Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
  4. 4 Oslo Delirium Research Group, Department of Geriatric Medicine, University of Oslo, Oslo, Norway
  5. 5 Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  1. Correspondence to Dr Sigurd Evensen; sigurd.evensen{at}ntnu.no

Abstract

Objectives It remains unclear if geriatric patients with different delirium motor subtypes express different levels of motor activity. Thus, we used two accelerometer-based devices to simultaneously measure upright activity and wrist activity across delirium motor subtypes in geriatric patients.

Design Cross-sectional study.

Settings Geriatric ward in a university hospital in Norway.

Participants Sixty acutely admitted patients, ≥75 years, with DSM-5-delirium.

Outcome measures Upright activity measured as upright time (minutes) and sit-to-stand transitions (numbers), total wrist activity (counts) and wrist activity in a sedentary position (WAS, per cent of the sedentary time) during 24 hours ongoing Delirium Motor Subtype Scalesubtyped delirium.

Results Mean age was 86.7 years. 15 had hyperactive, 20 hypoactive, 17 mixed and 8 had no-subtype delirium. We found more upright time in the no-subtype group than in the hypoactive group (119.3 vs 37.8 min, p=0.042), but no differences between the hyperactive, the hypoactive and the mixed groups (79.1 vs 37.8 vs 50.1 min, all p>0.28). The no-subtype group had a higher number of transitions than the hypoactive (54.3 vs 17.4, p=0.005) and the mixed groups (54.3 vs 17.5, p=0.013). The hyperactive group had more total wrist activity than the hypoactive group (1.238×104 vs 586×104 counts, p=0.009). The hyperactive and the mixed groups had more WAS than the hypoactive group (20% vs 11%, p=0.032 and 19% vs 11%, p=0.049).

Conclusions Geriatric patients with delirium demonstrated a low level of upright activity, with no differences between the hyperactive, hypoactive and mixed groups, possibly due to poor gait function. The hyperactive and mixed groups had more WAS than the hypoactive group, indicating true differences in motor activity across delirium motor subtypes, also in geriatric patients. Wrist activity appears more suitable than an upright activity for both diagnostic purposes and activity monitoring in geriatric delirium.

  • delirium
  • motor subtypes
  • geriatric
  • actigraphy
  • accelerometer

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Footnotes

  • Contributors SE did the initial drafting of the article, had the main responsibility for data collection and for diagnosing and subtyping of delirium. AKB processed and analysed the activity monitoring data. OS is the project manager and designed the study. He also participated in diagnosing and subtyping of delirium. SL had the main responsibility for the statistical analyses. IS participated in designing and planning the study with particular responsibility in data collection at the geriatric ward. TBW participated in designing and planning the study with particular responsibility in the diagnostic workup of delirium and subtyping. KT participated in designing and planning the study, with a particular responsibility in planning data collection with the accelerometer-based devices. All authors have critically read and approved the final manuscript.

  • Funding The Liaison Committee for education, research and innovation in Central Norway funded the project.

  • Disclaimer We confirm that the funding body had no role in designing the study, in the collection, analysis or interpretation of data or in writing/submitting of the manuscript.

  • Competing interests AKB worked at NTNU, Department of Neuromedicine and Movement Sciences, when completing his contribution to this article. After finishing his contribution, but before the article was submitted, he started working at Roche Pharmaceutical Research and Early Development (pREDi), Roche Innovation Center Basel, F.Hoffmann-La Roche Ltt, 124 Grenzacherstrasse, Basel, CH 4070, Switzerland.

  • Ethics approval The Regional Committee for Medical and Health Research Ethics of Mid-Norway approved the study (REK Central 2015/474).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Datasets from this study are not available since we do not have the consent to share the data neither from The Regional Committee for Medical and Health Research Ethics nor from the patients.

  • Presented at The material presented in this article was presented as an 8 min lecture at the European Delirium Association yearly meeting in 2017.

  • Patient consent for publication Not required.

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