Cited by 660Intensive Care Unit Cognitive DisordersAnesthesia and Sedative AgentsAlcoholism and Thiamine Deficiency

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Delirium and Its Motoric Subtypes: A Study of 614 Critically Ill Patients

Peterson, Josh F., Pun, Brenda T., Dittus, Robert S., Thomason, Jason W. W., Jackson, James C., Shintani, Ayumi K., Ely, E. Wesley·2006·Journal of the American Geriatrics Society

DOI 10.1111/j.1532-5415.2005.00621.x

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Abstract

OBJECTIVES: To describe the motoric subtypes of delirium in critically ill patients and compare patients aged 65 and older with a younger cohort. DESIGN: Prospective cohort study. SETTING: The medical intensive care unit (MICU) of a tertiary care academic medical center. PARTICIPANTS: Six hundred fourteen MICU patients admitted during a process improvement initiative to monitor levels of sedation and delirium. MEASUREMENTS: MICU nursing staff assessed delirium and level of consciousness in all MICU patients at least once per 12-hour shift using the Confusion Assessment Method for the Intensive Care Unit and the Richmond Agitation-Sedation Scale. Delirium episodes were categorized as hypoactive, hyperactive, and mixed type. RESULTS: Delirium was detected in 112 of 156 (71.8%) subjects aged 65 and older and 263 of 458 (57.4%) subjects younger than 65. Mixed type was most common (54.9%), followed by hypoactive delirium (43.5%) and purely hyperactive delirium (1.6%). Patients aged 65 and older experienced hypoactive delirium at a greater rate than younger patients (41.0% vs 21.6%, P<.001) and never experienced hyperactive delirium. Older age was strongly and independently associated with hypoactive delirium (adjusted odds ratio=3.0, 95% confidence interval=1.7-5.3), compared with no delirium in a model that adjusted for other important determinants of delirium including severity of illness, sedative medication use, and ventilation status. CONCLUSION: Older age is a strong predictor of hypoactive delirium in MICU patients, and this motoric subtype of delirium may be missed in the absence of active monitoring.

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Result
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BackgroundResult
Management of delirium in the intensive care unit
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Background
Representing New Voice Services and Their Features
Turner, K. J. (2003) · Stirling Online Research Repository (University of Stirling) · Cited by 11
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“10 The present study shows similar results, with predominant hypoactive delirium in ( n = 93, 44.9%), followed by hyperactive delirium ( n = 60, 29”
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Background
Impact of psychotic symptoms on clinical outcomes in delirium
Paik, S.-H., Ahn, J., Min, S., Park, K.-C., & Kim, M. (2018) · PLoS ONE · doi:10.1371/journal.pone.0200538 · Cited by 10
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Background
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“However, divergent studies documented higher prevalence rates for the no motor subtype (Godfrey et al., 2010; D. Meagher et al., 2012; D. J. Meagher et al., 2011; D. J. Meagher, O’Hanlon, O’Mahony, Casey, & Trzepacz, 2000) and hyperactive subtype (Pandharipande et al., 2007; Peterson et al., 2006).”
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Dexmedetomidine for the prevention of delirium in critically ill patients – A protocol for a systematic review
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Delayed awakening in neurocritical care
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de la Varga-Martínez, O., Badenes, R., Gordaliza, C., Manso, S. D. M., Castillo, G., Aragon, C. A., Castro, M. F., dos Santos, A. C. A., Herrero, R. L., Pérez, R. N., et al. (2025) · Revista Española de Anestesiología y Reanimación (English Edition) · doi:10.1016/j.redare.2025.501805 · Cited by 8
Vasopressor Therapy and the Brain: Dark Side of the Moon
Heming, N., Mazeraud, A., Azabou, É., Moine, P., & Annane, D. (2020) · Frontiers in Medicine · doi:10.3389/fmed.2019.00317 · Cited by 9
Preventive strategies and potential therapeutic interventions for delirium in sepsis
de Souza-Dantas, V. C., Póvoa, P. M. S. R., Bozza, F. A., Soares, M., & Salluh, J. I. (2016) · Hospital Practice · doi:10.1080/21548331.2016.1192453 · Cited by 8
“The most common type of delirium in the ICU is hypoactive.[30] Hypoactive delirium tends to occur more frequently in older”
Background
Jordanian Intensive Care Unit Nurses’ Knowledge of Delirium Recognition
AbuRuz, M. E. (2016) · Global Journal of Health Science · doi:10.5539/gjhs.v9n4p182 · Cited by 8
“6%) (Peterson et al., 2006).”
Haloperidol for delirium in critically ill patients – protocol for a systematic review
Barbateskovic, M., Kraus, S. R., Collet, M. O., Mathiesen, O., Jakobsen, J. C., Perner, A., & Wetterslev, J. (2018) · Acta Anaesthesiologica Scandinavica · doi:10.1111/aas.13088 · Cited by 8
Acute Kidney Injury and Delirium: Kidney–Brain Crosstalk
Wan, R., & Ostermann, M. (2019) · Annual update in intensive care and emergency medicine · doi:10.1007/978-3-030-06067-1_31 · Cited by 8
Delirium in the critically ill patient
Lorenzo, M., Aldecoa, C., & Rico, J. D. (2013) · Trends in Anaesthesia and Critical Care · doi:10.1016/j.tacc.2013.05.005 · Cited by 8
The detection of delirium in the ICU: An important aspect of care
Harroche, J., St‐Louis, L., & Gagnon, M. (2014) · Journal of Nursing Education and Practice · doi:10.5430/jnep.v4n9p135 · Cited by 8
“More specifically, Peterson, Pun, Dittus, Thomason, Jackson, Shintani, & Ely [19], in 2006, lead a prospective cohort study which included 614 critically ill patients admitted to a medical ICU of a tertiary care university teaching hospital.”
BackgroundInfluential
Recognizing Delirium Superimposed on Dementia
Inouye, S. K. (2007) · Digital Access to Scholarship at Harvard (DASH) (Harvard University) · Cited by 8
Prevalência do subdiagnóstico de delirium entre pacientes internados em unidade de terapia intensiva [Prevalence of under-diagnosis of delirium among patients in an intensive care unit]
Luna, A. A., Entringer, A. P., & da Silva, R. C. L. (2016) · Revista Enfermagem UERJ · doi:10.12957/reuerj.2016.6238 · Cited by 8
Assessment of delirium in the intensive care unit
Kallenbach, T., & Amado, L. (2017) · Southern African Journal of Anaesthesia and Analgesia · doi:10.1080/22201181.2017.1332809 · Cited by 8
Delirium in the Intensive Care Unit
Savio, R. D., & Venishetty, P. K. (2017) · Jaypee Brothers Medical Publishers (P) Ltd. eBooks · doi:10.5005/jp/books/13067_9 · Cited by 8
Risk Factors and Pain Management in the Incidence of Postoperative Delirium in Elderly Patients: A Retrospective Study
Vizerie, L., Morales, T., Galey, S., Montel, F., Velly, L. J., Bruder, N. J., & Simeone, P. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13247624 · Cited by 7
“Delirium manifests in several clinical forms: hyperactive, hypoactive, and mixed [3,4].”
Influential
Intensive Care Unit Delirium, Clinical Observations, and Patients' Statements
Granberg‐Axéll, A., & Bergbom, I. (2020) · Dimensions of Critical Care Nursing · doi:10.1097/dcc.0000000000000424 · Cited by 7
Advantages of score-based delirium detection compared to a clinical delirium assessment—a retrospective, monocentric cohort study
Jäckel, M., Aicher, N., Bemtgen, X., Rilinger, J., Zotzmann, V., Biever, P. M., Supady, A., Stachon, P., Duerschmied, D., Wengenmayer, T., et al. (2021) · PLoS ONE · doi:10.1371/journal.pone.0259841 · Cited by 7
“According to literature, hyperactive delirium presumed when diagnosed in conjunction with RASS � 1 and no RASS 0 in follow-up scores during delirium [28].”
Postoperative Delirium After Intracranial Surgery: A Retrospective Cohort Study
Kappen, P. R., Kappen, H. J., Dirven, C. M. F., Klimek, M., Jeekel, J., Andrinopoulou, E. R., Osse, R. J., & Vincent, A. J. P. E. (2023) · World Neurosurgery · doi:10.1016/j.wneu.2022.12.132 · Cited by 7
Prevention of Posttraumatic Stress Disorder in Intensive Care Unit Patients
Crabtree-Buckner, L., & Kautz, D. D. (2012) · Dimensions of Critical Care Nursing · doi:10.1097/dcc.0b013e3182445f21 · Cited by 7
“Delirium may be caused by analgesics and anxiolytics and it has been particularly associated with lorazepam.(3,5) A patient who has a history of depression, anxiety, and drug and/or alcohol abuse is also at risk of developing PTSD.”
Background
Assessing Delirium in the Intensive Care Unit
Sona, C. S. (2009) · Critical Care Nurse · doi:10.4037/ccn2009329 · Cited by 7
Delir und Delirmanagement bei kritisch kranken Patienten
Kersten, A., & Reith, S. (2016) · Medizinische Klinik - Intensivmedizin und Notfallmedizin · doi:10.1007/s00063-015-0130-z · Cited by 7
Prevalence of Delirium and Risk Factors in Heart Surgery Patients in Intensive Care Unit: A Retrospective study
Noh, E.-Y., & Park, Y. (2019) · Korean Journal of Adult Nursing · doi:10.7475/kjan.2019.31.2.146 · Cited by 7
“이는 Peterson 등[26]이 중환자실 환자를 대상으로 섬망종류를 조사한 연 구에서 활동저하섬망이 활동항진섬망보다 41.”
Delirium in the Intensive Care Unit: Is Dexmedetomidine Effective?
Ungarian, J., Rankin, J. A., & Then, K. L. (2019) · Critical Care Nurse · doi:10.4037/ccn2019591 · Cited by 7
A bibliometric analysis on delirium in intensive care unit from 2013–2023
Ma, X., Wu, Q., Ran, Y., Cao, X., & Zheng, H. (2025) · Frontiers in Neurology · doi:10.3389/fneur.2025.1469725 · Cited by 6
Predicting delirium in acute ischemic stroke: the PREDELIS score
Berger, N., Kramer, D., Schrempf, M., Hofer, E., Pichler, A., Fandler‐Höfler, S., Haidegger, M., Hatab, I., Heine, M., Jagiello, J., et al. (2025) · Journal of Neurology · doi:10.1007/s00415-025-13073-5 · Cited by 7
“To avoid an underestimation of delirium, NLS was used to search unstructured text for key words indicating delirious states: “delirium”, “delirious state”, “hyperactive”, “hypoac-tive”, “apathic”, “agitation”, “confusion”, “hallucination”, “restlessness”, “unsettled” and “anxious” [25–28].”
Assessing patterns of delirium symptoms reveals a novel subtype among elective surgical patients with postoperative delirium
Yang, L., Do, Q., Zhu, X., Leung, J. M., & Sands, L. P. (2024) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.6049 · Cited by 6
“For example, a study used the Richmond Agitation Sedation Score (RASS) to measure level of consciousness and did not include the cognitive symptoms of delirium 12 because the RASS does not include assessment of cognitive symptoms of delirium.”
Method
Investigation of Post-Transplant Mental Well-Being in Liver Transplant Recipients with Hepatic Encephalopathy
Sarıtaş, S., Tarlacı, S., Bülbüloğlu, S., & Guneş, H. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13113249 · Cited by 6
“The RASS score is between +1 and +4 in hyperactive individuals and between − 3 and 0 in hypoactive individuals [21].”
Background
Guía clínica y plan estratégico para la prevención, el diagnóstico y el tratamiento del delirium: Proyecto Delirium Zero
de la Varga-Martínez, O., Badenes, R., Gordaliza, C., Manso, S. D. M., Castillo, G. E. L., Aragon, C. A., Castro, M. F., Santos, A. B. M., Herrero, R. L., Pérez, R. N., et al. (2025) · Revista Española de Anestesiología y Reanimación · doi:10.1016/j.redar.2025.501805 · Cited by 6
Delirium identification, prevention and management in intensive care units in England, Wales and Northern Ireland: a survey of practice
Gibbison, B., Johnson, A. F., Rowan, K., Parslow, R. M., Moore, A. J., Smith, S. C., Long, J., Potter, M., Pufulete, M., & the OPTIC Study Group (2025) · Anaesthesia · doi:10.1111/anae.16728 · Cited by 7
“The ICUs were content that the CAM-ICU was useful for diagnosing hyperactive delirium but were less certain that the CAM-ICU could identify other motoric subtypes of delirium (hypoactive and mixed) [16].”
Deliryumun Değerlendirilmesinde Sık Kullanılan Ölçüm Araçlarının İncelenmesi
Dallı, Ö. E., & Girgin, N. K. (2020) · Uludağ Üniversitesi Tıp Fakültesi Dergisi · doi:10.32708/uutfd.676518 · Cited by 6
Effect of Tropisetron on Prevention of Emergence Delirium in Patients After Noncardiac Surgery
Sun, Y., Lin, D., Wang, J., Geng, M., Xue, M., Lang, Y., Cui, L., Hao, Y., Mu, S., Wu, D., et al. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.13443 · Cited by 6
The Combined Effect of Delirium and Falls on Length of Stay and Discharge
Kalivas, B. C., Zhang, J., Harper, K., Dulin, J. D., Heincelman, M. E., Marsden, J. E., Hunt, K. J., Mauldin, P. D., Moran, W. P., & Thomas, M. K. (2023) · Journal for Healthcare Quality · doi:10.1097/jhq.0000000000000377 · Cited by 6
Psychiatric Aspects of Lung Disease in Critical Care
Sher, Y. I. (2017) · Critical Care Clinics · doi:10.1016/j.ccc.2017.03.014 · Cited by 6
Prävention des Delirs auf der Intensivstation
Braune, S. A., & Gurlit, S. (2019) · DMW - Deutsche Medizinische Wochenschrift · doi:10.1055/a-0666-3947 · Cited by 6
“Die Symptomatik ist sehr variabel und fluktuierend – von hypoaktiven bis zu hyperaktiven Formen, meist in Kombination auftretend [2, 3].”
Background
Dexmedetomidine for the management of delirium in critically ill patients—A protocol for a systematic review
Maagaard, M., Barbateskovic, M., Perner, A., Jakobsen, J. C., & Wetterslev, J. (2019) · Acta Anaesthesiologica Scandinavica · doi:10.1111/aas.13329 · Cited by 6
Subtypes of Delirium: A Step Toward Precision Medicine*
Stevens, R. D., & Zink, E. K. (2018) · Critical Care Medicine · doi:10.1097/ccm.0000000000003462 · Cited by 6
“Nonetheless, the study by Krewulak et al (9) has some important findings which increase confidence in previously published observations (10, 11), and which have biologic plausibility.”
Background
Considering Causes for Hypoactive Delirium
Mulkey, M., Hardin, S. R., Olson, D. M., Munro, C. L., & Everhart, D. E. (2019) · Australasian Journal of Neuroscience · doi:10.21307/ajon-2017-015 · Cited by 6
Motoric Subtypes of Delirium—More Evidence for the Importance of Routine Delirium Screening
Burhanullah, M. H., & Neufeld, K. J. (2018) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2018.09.002 · Cited by 6
Intraoperative methylene blue infusion reduces postoperative delirium in patients undergoing pancreatic surgery: A randomized controlled clinical trial
Deng, Y., Dong, J., Pan, C., Deng, L., He, Z., Yang, L., Hua, J., & Zhang, J. (2025) · Journal of Clinical Anesthesia · doi:10.1016/j.jclinane.2025.112060 · Cited by 6
Study on the occurrence of delirium in geriatric patients undergoing hip fracture surgery
Fraccalini, T., Ricci, V., TAROZZO, B., Cardinale, L., Garofalo, G., Primerano, G., Boccuzzi, A., Trogolo, A., Maina, G., Minniti, D., et al. (2024) · Minerva Psychiatry · doi:10.23736/s2724-6612.24.02524-7 · Cited by 5
The Role of Delirium and Other Risk Factors on Mortality in Elderly Patients with Critical Limb Ischemia Undergoing Major Lower Limb Amputation
Roijers, J. P., Hopmans, C. J., Janssen, T. L., Mulder, P. G. H., Buimer, M. G., Ho, G. H., de Groot, H. G. W., Veen, E. J., & van der Laan, L. (2019) · Annals of Vascular Surgery · doi:10.1016/j.avsg.2019.02.014 · Cited by 5
Pediatric Neurocritical Care: Maximizing Neurodevelopmental Outcomes Through Specialty Care
Riggs, B. J., & Carpenter, J. L. (2023) · Pediatric Neurology · doi:10.1016/j.pediatrneurol.2023.08.006 · Cited by 6

Authors: Peterson, J. F., Pun, B. T., Dittus, R. S., Thomason, J. W. W., Jackson, J. C., Shintani, A. K., & Ely, E. W.
Affiliations: Vanderbilt University Medical Center (US)
VA Tennessee Valley Healthcare System (US)
Corresponding author: Peterson, Josh F.
Ely, E. Wesley
ORCID: Peterson, Josh F.
Jackson, James C.
Shintani, Ayumi K.
Ely, E. Wesley
Venue: Journal of the American Geriatrics Society
Publisher: Wiley
Published: 2006-03
Volume: 54
Issue: 3
Pages: 479-484
ISSN: 0002-8614 (ISSN-L)
1532-5415
DOI: 10.1111/j.1532-5415.2005.00621.x
OpenAlex: W1505808688
Cited by: 660
References: 31
Citations by year: 2026: 11 · 2025: 17 · 2024: 32 · 2023: 37 · 2022: 21 · 2021: 33 · 2020: 32 · 2019: 45 · 2018: 44 · 2017: 41 · 2016: 48 · 2015: 37 · 2014: 29 · 2013: 42 · 2012: 44
FWCI: 27.31
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Journal of the American Geriatrics Society (publishedVersion)
PubMed (publishedVersion)
Funders: Eli Lilly and Company
Pfizer
Topics: Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
Health Sciences › Medicine › Clinical Neurology › Alcoholism and Thiamine Deficiency
Keywords: delirium, hypoactive delirium, hyperactive delirium, mixed delirium, critically ill patients, older adults, intensive care unit, age as predictor, sedation, level of consciousness, delirium monitoring
MeSH terms: Age Factors, Aged, Critical Care, Delirium, Female, Follow-Up Studies, Humans, Male, Motor Activity, Prognosis, Prospective Studies, Severity of Illness Index, Incidence, Prevalence, Critical Illness

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Delirium and Its Motoric Subtypes: A Study of 614 Critically Ill Patients

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