Paula T Trzepacz

Publications (107) View all

• Article: Reliability of delirium rating scale (DRS) and delirium rating scale-revised-98 (DRS-R98) using variance-based multivariate modelling.

  Dimitrios Adamis, Chantal J Slor, Maeve Leonard, Joost Witlox, Jos F M de Jonghe, Alastair J D Macdonald, Paula Trzepacz, David Meagher
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  ABSTRACT: Delirium's characteristic fluctuation in symptom severity complicates the assessment of test-retest reliability of scales using classical analyses, but application of modelling to longitudinal data offers a new approach. We evaluated test-retest reliability of the delirium rating scale (DRS) and delirium rating scale-revised-98 (DRS-R98), two widely used instruments with high validity and inter-rater reliability. Two existing longitudinal datasets for each scale included DSM-IV criteria for delirium diagnosis and repeated measurements using the DRS or DRS-R98. To estimate the reliability coefficients RT and RΛ for each scale we used a macros provided by Dr. Laenen at http://www.ibiostat.be/software/measurement.asp. For each dataset a linear mixed-effects model was fitted to estimate the variance-covariance parameters. A total of 531 cases with between 4 and 9 measurement points across studies including both delirious and non-delirious patients. Comorbid dementia in the datasets varied from 27% to 55%. Overall RT for the DRS were 0.71 and 0.50 and for DRS-R98 0.75 and 0.84. RΛ values for DRS were 0.99 and 0.98 and for DRS-R98 were 0.92 and 0.96. Individual RT measures for DRS-R98 and DRS across visits within studies showed more range than overall values. Our models found high overall reliability for both scales. Multiple factors impact a scale's reliability values including sample size, repeated measurements, patient population, etc in addition to rater variability.
  Journal of psychiatric research 03/2013; · 3.72 Impact Factor
• Article: Replication analysis for composition of the Delirium Motor Subtype Scale (DMSS) in a referral cohort from Northern India.

  Sandeep Grover, Surendra K Mattoo, Krishnan Rajalakshmi Aarya, Partha Pratim Das, Kaustav Chakrabarty, Paula Trzepacz, Nitin Gupta, David Meagher
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  ABSTRACT: The Delirium Motor Subtype Scale (DMSS) was developed by discerning the best differentiating motor activity symptoms from the Delirium Motor Checklist (DMC), a compilation of psychomotor symptoms from other subjective scales. To broaden its validation we replicated the original work done in a palliative care population in a psychiatric referral population. 100 consecutive C/L Psychiatry referrals with DSM-IV delirium in an Indian general hospital were assessed with the Delirium Rating Scale-Revised-98 (DRS-R98) and DMC and compared to 60 nondelirious hospitalized controls. Disturbances of motor activity were almost invariably present in patients with delirium and at a much higher frequency than in nondelirious control subjects. Principal components analysis identified 5-factors for the DMC where Factor 1 explained 37.3% of the variance and correlated significantly with DRS-R98 motor items. Items loading at >0.65 were selected for the replication scale if they also either correlated significantly with DRS-R98 motor items or were significantly more frequent in delirious patients vs. controls. The resultant scale comprised 12 items (five hyperactive and seven hypoactive) and was similar to the original DMSS. Combining motor items from the original DMSS and replicated version produced a 13-item amended DMSS that may have broader generalizability than the original DMSS.
  Psychiatry research. 09/2012;
• Article: Features of subsyndromal and persistent delirium.

  David Meagher, Dimitrios Adamis, Paula Trzepacz, Maeve Leonard
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  ABSTRACT: Longitudinal studies of delirium phenomenology are lacking. We studied features that characterise subsyndromal delirium and persistent delirium over time. Twice-weekly evaluations of 100 adults with DSM-IV delirium using the Delirium Rating Scale-Revised-98 (DRS-R98) and Cognitive Test for Delirium (CTD). The generalised estimating equation method identified symptom patterns distinguishing full syndromal from subsyndromal delirium and resolving from persistent delirium. Participants (mean age 70.2 years (s.d. = 10.5)) underwent 323 assessments (range 2-9). Full syndromal delirium was significantly more severe than subsyndromal delirium for DRS-R98 thought process abnormalities, delusions, hallucinations, agitation, retardation, orientation, attention, and short- and long-term memory items, and CTD attention, vigilance, orientation and memory. Persistent full syndromal delirium had greater disturbance of DRS-R98 thought process abnormalities, delusions, agitation, orientation, attention, and short- and long-term memory items, and CTD attention, vigilance and orientation. Full syndromal delirium differs from subsyndromal delirium over time by greater severity of many cognitive and non-cognitive symptoms. Persistent delirium involves increasing prominence of recognised core diagnostic features and cognitive impairment.
  The British journal of psychiatry: the journal of mental science 11/2011; 200(1):37-44. · 6.62 Impact Factor
• Article: Neuropsychiatric symptoms in Alzheimer's disease.

  Constantine G Lyketsos, Maria C Carrillo, J Michael Ryan, Ara S Khachaturian, Paula Trzepacz, Joan Amatniek, Jesse Cedarbaum, Robert Brashear, David S Miller
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  ABSTRACT: Neuropsychiatric symptoms (NPS) are core features of Alzheimer's disease and related dementias. Once thought to emerge primarily in people with late-stage disease, these symptoms are currently known to manifest commonly in very early disease and in prodromal phases, such as mild cognitive impairment. Despite decades of research, reliable treatments for dementia-associated NPS have not been found, and those that are in widespread use present notable risks for people using these medications. An Alzheimer's Association Research Roundtable was convened in the spring of 2010 to review what is known about NPS in Alzheimer's disease, to discuss classification and underlying neuropathogenesis and vulnerabilities, and to formulate recommendations for new approaches to tailored therapeutics.
  Alzheimer's & dementia: the journal of the Alzheimer's Association 09/2011; 7(5):532-9. · 5.90 Impact Factor
• Article: Phenomenological and neuropsychological profile across motor variants of delirium in a palliative-care unit.

  Maeve Leonard, Sinead Donnelly, Marion Conroy, Paula Trzepacz, David J Meagher
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  ABSTRACT: Studies using composite measurement of cognition suggest that cognitive performance is similar across motor variants of delirium. The authors assessed neuropsychological and symptom profiles in 100 consecutive cases of DSM-IV delirium allocated to motor subtypes in a palliative-care unit: Hypoactive (N=33), Hyperactive (N=18), Mixed (N=26), and No-Alteration motor groups (N=23). The Mixed group had more severe delirium, with highest scores for DRS-R-98 sleep-wake cycle disturbance, hallucinations, delusions, and language abnormalities. Neither the total Cognitive Test for Delirium nor its five neuropsychological domains differed across Hyperactive, Mixed, and Hypoactive motor groups. Most patients (70%) with no motor alteration had DRS-R-98 scores in the mild or subsyndromal range even though they met DSM-IV criteria. Motor variants in delirium have similar cognitive profiles, but mixed cases differ in expression of several noncognitive features.
  The Journal of neuropsychiatry and clinical neurosciences 01/2011; 23(2):180-8. · 2.34 Impact Factor