Outcome Differences by Delirium Motor Subtype in Patients with Ischemic Stroke

OBJECTIVE: This study evaluated the outcomes of ischemic stroke patients according to delirium motor subtype.METHODS: This study included patients who were admitted to the stroke unit between August 2017 and March 2019 and met the DSM-5 diagnostic criteria for delirium. Patients were assessed twice weekly throughout their delirium episodes using the Korean version of the Delirium Motor Subtype Scale (K-DMSS) and the Korean version of the Delirium Rating Scale-Revised-98 (K-DRS-98). The clinical characteristics and short-term outcomes of the patients were also assessed.RESULTS: A total of 943 stroke patients were included; the rate of incident delirium was 10.18%. Of the 95 delirium patients, 34 were classified as the hyperactive subtype, 30 as the mixed subtype, 25 as the hypoactive and six as no subtype. Among the subtype groups, the hypoactive subtype had the highest initial scores on the National Institutes of Health Stroke Scale (NIHSS; 6.72±4.75, p=0.02) and the modified Rankin Scale (mRS; 3.96±1.24, p<0.01). Additionally, the mixed and hypoactive subtypes had longer durations (p<0.01) and more severe symptoms of delirium (p=0.03) than the other motor subtypes, and the hypoactive subtype group had a significantly longer hospital stay (36.88±27.71 days, p<0.01) than the other subtype groups. After adjusting for baseline covariates in a multiple linear regression analysis, these differences remained significant.CONCLUSION: The present results suggest that the motor subtype of delirium is associated with different characteristics and outcomes in ischemic stroke patients.

Empeoramiento de la enfermedad de Parkinson y componentes de subtipo motor influencia la condición física / Agravo da doença de Parkinson e subtipo motor influencia componentes da capacidade física / Parkinson's disease severity and motor subtype influence physical capacity components

The severity of Parkinson's disease (PD) and PD's motor subtypes influence the components of physical capacity. The aim of this study was to investigate the impact of both PD severity and motor subtype in the performance of these components. Thirty-six PD patients were assigned into four groups: Tremor (TD) initial and TD mild, akinetic-rigid (AR) initial, and AR mild. Patients' strength, balance, coordination, mobility and aerobic capacity were evaluated and groups were compared using a two-way ANOVA (severity and subtype as factors). AR presents a poorer performance than TD in almost all tests. Also this performance was worsened with the advance of the disease in AR, contrary to TD. We conclude that AR and TD subgroups are different about their performance on physical capacity components, moreover, this performance worsens with the advance of the disease of the AR group, but not for TD.

A doença de Parkinson (DP) é caracterizada por diferentes subtipos motores e supõe-se que o desempenho dos componentes da capacidade física é influenciado por esses subtipos. O objetivo desse estudo foi investigar o impacto que a severidade e o subtipo da DP podem trazer sobre o desempenho dos componentes da capacidade física. Trinta e seis pacientes com DP foram distribuídos em quarto grupos: com dominância de tremor (TD) inicial e TD intermediário ou acinesia (AR) inicial e AR intermediário. A força, equilíbrio, coordenação, mobilidade e capacidade aeróbia foram avaliados. AR apresentou um pior desempenho que TD em nos testes. Esse desempenho foi pior com o aumento da severidade da doença em AR, mas não em TD. Conclui-se que os grupos AR e TD são diferentes em relação ao desempenho dos componentes da capacidade física, mas principalmente, esse desempenho piora com o avanço da doença em AR, mas não em TD.

La enfermedad de Parkinson (EP) se caracteriza por subtipos motor, y se supone que el rendimiento de los componentes físicos de capacidad es influenciada por aquellos subtipos. El objetivo de este estudio fue investigar el impacto tanto de la severidade y subtipo de la PD en el rendimiento de estos componentes. Treinta y seis pacientes con EP se distribuyeron en: Temblor (TD) inicial y TD suave, acinesia (AR) inicial y AR suave. Fuerza, equilibrio, coordinación, la movilidad y la capacidad aeróbica fueron evaluados. AR presenta un desempeño más pobre que TD en las pruebas. También este comportamiento se agravó con el avance de la enfermedad en AR, diferente que en TD. Como conclusión AR y TD son diferentes en respecto a su rendimiento en los componentes físicos de capacidad, pero sobre todo, esto empeora con el aumento de avance de la enfermedad en el grupo de AR, pero no en TD.

The Pattern of Cognitive Impairment Associated with the Motor Subtype in Parkinson's Disease

BACKGROUND: Previous studies have found over-representation of a postural instability and gait difficulty(PIGD) motor subtype in Parkinsons disease with dementia(PD-D). METHODS: One hundred twenty patients with Parkinson's disease(PD) were included in this study. All patients were evaluated by the Unified Parkinson's Disease Rating Scale(UPDRS) and neuropsychological tests. On the basis of the criteria for dementia(DSM-IV) and the results of the neuropsychological assessments, the patients were divided into the following three groups: (1) non-demented(PD-ND), (2) mild cognitive impairment(PD-MCI), and (3) dementia (PD-D). In addition, patients were also grouped into the following two phenotypes based on the UPDRS components: (1) tremor and (2) postural instability gait difficulty(PIGD)-predominant. We also analyzed the clinical characteristics and subtypes of the disease. In addition, the relationship between the cognitive impairments and the parkinsonian motor handicaps was evaluated. RESULTS: There was a significant relationship between cognitive impairment and the motor subtypes. The PIGD group had a higher prevalence of PD-D than the other group. In addition, there were significant correlations between the general cognitive functions and motor handicaps, especially those with axial symptoms. Multiple logistic regression analysis showed that the motor subtype was independently associated with the cognitive decline in PD. CONCLUSION: These findings support that cognitive decline in patients with PD is associated with a specific motor subtype. This association might be explained by the involvement of non-dopaminergic pathways. These results have implications for the clinical management of PD with regard to the motor symptoms and cognition.