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A comparison of the revised Delirium Rating Scale (DRS–R98) and the Memorial Delirium Assessment Scale (MDAS) in a palliative care cohort with DSM–IV delirium

  • Roisin O'Sullivan (a1) (a2), David Meagher (a1) (a3) (a2), Maeve Leonard (a1) (a3) (a2), Leiv Otto Watne (a4) (a5), Roanna J Hall (a6) (a7), Alasdair M.J. Maclullich (a6) (a7), Paula Trzepacz (a8) (a9) (a10) and Dimitrios Adamis (a3) (a2) (a11) (a12)...



Assessment of delirium is performed with a variety of instruments, making comparisons between studies difficult. A conversion rule between commonly used instruments would aid such comparisons. The present study aimed to compare the revised Delirium Rating Scale (DRS–R98) and Memorial Delirium Assessment Scale (MDAS) in a palliative care population and derive conversion rules between the two scales.


Both instruments were employed to assess 77 consecutive patients with DSM–IV delirium, and the measures were repeated at three-day intervals. Conversion rules were derived from the data at initial assessment and tested on subsequent data.


There was substantial overall agreement between the two scales [concordance correlation coefficient (CCC) = 0.70 (CI 95 = 0.60–0.78)] and between most common items (weighted κ ranging from 0.63 to 0.86). Although the two scales overlap considerably, there were some subtle differences with only modest agreement between the attention (weighted κ = 0.42) and thought process (weighted κ = 0.61) items. The conversion rule from total MDAS score to DRS–R98 severity scores demonstrated an almost perfect level of agreement (r = 0.86, CCC = 0.86; CI 95 = 0.79–0.91), similar to the conversion rule from DRS–R98 to MDAS.

Significance of results:

Overall, the derived conversion rules demonstrated promising accuracy in this palliative care population, but further testing in other populations is certainly needed.


Corresponding author

Address correspondence and reprint requests to: Dimitrios Adamis, Sligo Mental Health Services, Clarion Road, Sligo, Ireland. E-mail:


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Adamis, D., Sharma, N., Whelan, P.J., et al. (2010). Delirium scales: A review of current evidence. Aging & Mental Health, 14(5), 543555.
Bland, J.M. & Altman, D.G. (1986). Statistical methods for assessing agreement between two methods of clinical measurement. Lancet, 1(8476), 307310.
Breitbart, W. & Alici, Y. (2012). Evidence-based treatment of delirium in patients with cancer. Journal of Clinical Oncology, 30(11), 12061214.
Breitbart, W., Rosenfeld, B., Roth, A., et al. (1997). The Memorial Delirium Assessment Scale. Journal of Pain and Symptom Management, 13(3), 128137.
Cohen, J. (1968). Weighted kappa: Nominal scale agreement with provision for scaled disagreement or partial credit. Psychological Bulletin, 70(4), 213220.
Fleiss, J.L., Cohen, J. & Everitt, B.S. (1969). Large sample standard errors of kappa and weighted kappa. Psychological Bulletin, 72, 323327.
Franco, J.G., Trzepacz, P.T., Meagher, D.J., et al. (2012). Three core domains of delirium validated using exploratory and confirmatory factor analyses. Psychosomatics, 54(3), 227238.
Goodman, L.A. & Kruskal, W.H. (1963). Measures of association for cross-classifications. Journal of the American Statistical Association, 58, 310364.
Kazmierski, J., Kowman, M., Banach, M., et al. (2008). Clinical utility and use of DSM–IV and ICD–10 criteria and the Memorial Delirium Assessment Scale in establishing a diagnosis of delirium after cardiac surgery. Psychosomatics, 49(1), 7376.
Kiely, D.K., Jones, R.N., Bergmann, M.A., et al. (2007). Association between psychomotor activity delirium subtypes and mortality among newly admitted post-acute facility patients. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 62(2), 174179.
Kobayashi, K., Takeuchi, O., Suzuki, M., et al. (1992). A retrospective study on delirium type. Japanese Journal of Psychiatry and Neurology, 46(4), 911917.
Kolen, M.J. & Tong, Y. (2005). Classical test score equating. In Encyclopedia of statistics in behavioral science. Everitt, B.S. & Howell, D.C. (eds.), pp. 282287. Chichester: John Wiley & Sons.
Leonard, M., Raju, B., Conroy, M., et al. (2008). Reversibility of delirium in terminally ill patients and predictors of mortality. Palliative Medicine, 22(7), 848854.
Lin, L.I. (1989). A concordance correlation coefficient to evaluate reproducibility. Biometrics, 45, 255268.
Liptzin, B. & Levkoff, S.E. (1992). An empirical study of delirium subtypes. British Journal of Psychiatry, 161, 843845.
Marcantonio, E., Ta, T., Duthie, E., et al. (2002). Delirium severity and psychomotor types: their relationship with outcomes after hip fracture repair. Journal of the American Geriatrics Society, 50(5), 850857.
Mattoo, S.K., Grover, S., Chakravarty, K., et al. (2012). Symptom profile and etiology of delirium in a referral population in northern India: Factor analysis of the DRS–R98. Journal of Neuropsychiatry & Clinical Neurosciences, 24(1), 95101.
Meagher, D., Moran, M., Raju, B., et al. (2008). A new data-based motor subtype schema for delirium. Journal of Neuropsychiatry & Clinical Neurosciences, 20(2), 185193.
Meagher, D.J., Leonard, M., Donnelly, S., et al. (2011). A longitudinal study of motor subtypes in delirium: relationship with other phenomenology, etiology, medication exposure and prognosis. Journal of Psychosomatic Research, 71(6), 395403.
Meagher, D.J., McLoughlin, L., Leonard, M., et al. (2013). What do we really know about the treatment of delirium with antipsychotics? Ten key issues for delirium pharmacotherapy. American Journal of Geriatric Psychiatry. 21(12), 12231238.
Olofsson, S.M., Weitzner, M.A., Valentine, A.D., et al. (1996). A retrospective study of the psychiatric management and outcome of delirium in the cancer patient. Supportive Care in Cancer, 4(5), 351357.
Olsson, U. (1979). Maximum likelihood estimation of the polychoric correlation coefficient. Psychometrika, 44(4), 443460.
Revelle, W. (2013). Psych: Procedures for Personality and psychological research, Version 1.3.2. Available at
Ryan, D.J., O'Regan, N.A., Caoimh, R.O., et al. (2013). Delirium in an adult acute hospital population: Predictors, prevalence and detection. BMJ Open, 3(1).
Shyamsundar, G., Raghuthaman, G., Rajkumar, A.P., et al. (2009). Validation of the memorial delirium assessment scale. Journal of Critical Care, 24(4), 530534.
Svensson, E. (2000). Concordance between ratings using different scales for the same variable. Statistics in Medicine, 19(24), 34833496.
Trzepacz, P.T., Mittal, D., Torres, R., et al. (2001). Validation of the Delirium Rating Scale–Revised-98: Comparison with the Delirium Rating Scale and the cognitive test for delirium. Journal of Neuropsychiatry & Clinical Neurosciences, 13(2), 229242.
Trzepacz, P.T., Maldonado, J.R., Kean, J., et al. (2010). The Delirium Rating Scale–Revised-98 (DRS–R98) administration manual: A guide to increase understanding of how to solicit delirium symptoms to administer the DRS–R98. Indianapolis: Trzepacz.
World Medical Association (2014). Declaration of Helsinki: Ethical principles for research involving human subjects. [1964, amended 2008]. Available at



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