How do predisposing factors differ between delirium motor subtypes? A systematic review and meta-analysis

Area of Science:

• Gerontology
• Neuroscience
• Clinical Medicine

Background:

• Delirium is a prevalent neurocognitive disorder in hospitalized older adults, carrying significant negative outcomes.
• Motor activity profiling (hypoactive, hyperactive, mixed) is the primary method for subtyping delirium.

Purpose of the Study:

• To systematically review and meta-analyze predisposing factors that differentiate between delirium motor subtypes.
• To provide quantitative evidence for clinical assumptions regarding frailty indices in hypoactive delirium.

Main Methods:

• Systematic search of Medline, PsycINFO, and Embase databases for studies on predisposing factors of delirium motor subtypes.
• Inclusion of 61 studies with 14,407 participants (mean age 73.63 years).
• Random-effects meta-analyses to synthesize differences across 22 factors between delirium motor subtypes.

Main Results:

• Hypoactive delirium cases were older, had poorer cognition, higher physical risk scores, and were more likely to be women, care home residents, on more medications, with worse functional performance and cerebrovascular disease history.
• Hyperactive delirium cases were younger, more likely men, with better cognition and lower physical risk scores compared to other subtypes.
• Individuals with unclassified motor subtypes were more likely women with better functional performance; effect sizes were small.

Conclusions:

• Significant pre-delirium differences exist between motor subtypes, supporting the association of frailty indices with hypoactive delirium.
• Motor subtyping of delirium should be consistently measured in research.
• Delirium motor subtyping holds potential for improved clinical risk assessment and management.