The Delirium Rating Scale (DRS) quantitates multiple parameters affected by delirium. The scale can be used by a clinician to evaluate a patient with delirium and to monitor the response to therapy. The authors are from the University of Pittsburgh.
Items:
(1) temporal onset of symptoms
(2) perceptual disturbances
(3) hallucination type
(4) delusions
(5) psychomotor behavior
(6) cognitive status during formal testing
(7) physical disorder
(8) sleep-wake cycle disturbance
(9) lability of mood
(10) variability of symptoms
Descriptions:
(1) temporal onset of symptoms: The time course over which the symptoms appear. The maximum rating is for the most abrupt onset of symptoms, which is a common pattern for delirium. Dementia is usually more gradual in onset. Sometimes delirium can be chronic.
(2) perceptual disturbances: The maximum rating is for an extreme inability to perceive differences between internal and external reality.
(3) hallucination type: Tactile hallucinations are classically described in delirium.
(4) delusions: Delusions may be present in many different psychiatric disorders but tend to be better organized and more fixed in nondelirious disorders. Poorly formed delusions, often of a paranoid nature, are typical of delirium.
(5) psychomotor behavior: This describes degrees of severity of altered psychomotor behavior. Maximum points are given for severe agitation or severe withdrawal, indicating either the hyperactive or hypoactive variants of delirium respectively.
(6) cognitive status during formal testing: This requires information from the cognitive portion of a routine mental status examination.
(7) physical disorder: Delirium usually has at least 1 identifiable physical or physiological cause. Dementias often do not have a specific underlying cause.
(8) sleep-wake cycle disturbance: Disruption of the sleep-wake cycle is typical in delirium.
(9) lability of mood: Rapid shifts in mood can occur in various organic mental syndromes. Delirious patients might score points on any of the items depending upon the severity of the delirium and the underlying psychological state.
(10) variability of symptoms: The hallmark of delirium is the waxing and waning of symptoms.
|
Item |
Finding |
Points |
|---|---|---|
|
temporal onset of symptoms |
no significant change from longstanding behavior (chronic or chronic-recurrent state) |
0 |
|
|
gradual onset of symptoms |
1 |
|
|
acute change in behavior or personality occurring over a month |
2 |
|
|
abrupt change in behavior, usually occurring over a 1-3 day period |
3 |
|
perceptual disturbances |
none evident by history or observation |
0 |
|
|
feelings of depersonalization or derealization |
1 |
|
|
visual illusions or misperceptions |
2 |
|
|
evidence that that patient is markedly confused about external reality |
3 |
|
hallucination type |
hallucinations not present |
0 |
|
|
auditory hallucinations only |
1 |
|
|
visual hallucinations present, with or without auditory hallucinations |
2 |
|
|
tactile, olfactory or gustatory hallucinations present with or without visual or auditory hallucinations |
3 |
|
delusions |
none |
0 |
|
|
delusions are systematized (well-organized and persistent) |
1 |
|
|
delusions are new and not part of a pre-existing primary psychiatric disorder |
2 |
|
|
delusions are not well circumscribed; are transient; are poorly organized; most appear to be in response to misperceived environmental cues |
3 |
|
psychomotor behavior |
no significant retardation or agitation |
0 |
|
|
mild restlessness, tremulousness, or anxiety; a change from patient's usual behavior |
1 |
|
|
moderate agitation with pacing, etc. |
2 |
|
|
severe agitation; requires restraints; may be combative |
3 |
|
|
significant withdrawal from the environment that is not part of a pre-existing psychiatric condition |
3 |
|
cognitive status during formal testing |
no cognitive deficits, or deficits due to lack of education, mental retardation or other cause |
0 |
|
|
very mild cognitive deficits |
1 |
|
|
cognitive deficit largely in 1 major area tested, but otherwise intact |
2 |
|
|
significant cognitive deficits which are diffuse (affecting many different areas); concentration is reduced; registration and/or recall are abnormal |
3 |
|
|
severe cognitive deficits (motor or verbal perseverations, confabulations, disorientation, recent memory deficits, inability to cooperate with testing) |
4 |
|
physical disorder |
none |
0 |
|
|
presence of any physical disorder which might affect mental state |
1 |
|
|
specific problem (drug, infection, metabolic disorder, CNS lesion) that can be temporarily implicated in causing an altered mental status or behavior |
2 |
|
sleep-wake cycle disturbance |
not present; awake and alert during day; sleeps without significant disruptions at night |
0 |
|
|
occasional drowsiness during the day; mild sleep continuity disturbance at night |
1 |
|
|
frequent napping; unable to sleep at night (may show a reversal of day-sleep cycle) |
2 |
|
|
drowsiness prominent; difficulty in staying alert during the interview |
3 |
|
|
drifts into stuporous or comatose periods |
4 |
|
lability of mood |
none; mood stable |
0 |
|
|
affect or mood somewhat altered and changes over the course of hours |
1 |
|
|
significant mood changes which are inappropriate to the situation |
2 |
|
|
severe disinhibition of emotions |
3 |
|
variability of symptoms |
symptoms stable and mostly present during daytime |
0 |
|
|
symptoms worsen at night |
2 |
|
|
symptoms show a fluctuating intensity (wax and wane during a 24 hour period) |
4 |
delirium rating scale score =
= SUM(points for all 10 items)
Interpretation:
• minimum score: 0
• maximum score: 32
• A high score is associated with delirium, while dementia, schizophrenia and other conditions tend to give low scores (< 10).
• In patients with delirium, the higher the score, the more severe is the delirium.
Performance:
• The score correlates significantly with the impairment shown on cognitive tests.
• The inter-rater reliability was high. The intraclass correlation coefficient was 0.97
Specialty: Neurology
