Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2016 Dec;64(12):2424-2432.
doi: 10.1111/jgs.14511. Epub 2016 Nov 12.

Effect of Cognitively Stimulating Activities on Symptom Management of Delirium Superimposed on Dementia: A Randomized Controlled Trial

Ann Kolanowski  1 , Donna Fick  1 , Mark Litaker  2 , Paula Mulhall  3 , Linda Clare  4 , Nikki Hill  1 , Jacqueline Mogle  1 , Malaz Boustani  5 , David Gill  6   7 , Andrea Yevchak-Sillner  1
Affiliations
Randomized Controlled Trial

Effect of Cognitively Stimulating Activities on Symptom Management of Delirium Superimposed on Dementia: A Randomized Controlled Trial

Ann Kolanowski et al. J Am Geriatr Soc. 2016 Dec.

Abstract

Objective: To determine whether cognitively stimulating activities would reduce duration and severity of delirium and improve cognitive and physical function to a greater extent than usual care.

Design: Single-blind randomized clinical trial.

Setting: Eight post-acute care (PAC) facilities.

Participants: Community-dwelling older adults with dementia and delirium (N = 283).

Intervention: Research staff provided cognitively stimulating activities daily for up to 30 days.

Measurements: Primary outcomes were delirium duration (Confusion Assessment Method) and delirium severity (Delirium Rating Scale). Secondary outcomes were cognitive function (Digits Forward, Montreal Cognitive Assessment, CLOX) and physical function (Barthel Index).

Results: Mean percentage of delirium-free days (intervention: 64.8%, 95% confidence interval (CI) = 59.6-70.1; control: 68.7%, 95% CI = 63.9-73.6; P = .37, Wilcoxon rank sum test) and delirium severity (range 0-39: intervention: 10.77, 95% CI = 10.10-11.45; control: 11.15, 95% CI = 10.50-11.80; difference 0.37, 95% CI = 0.56-1.31, P = .43) were similar in both groups. Significant differences for secondary outcomes favoring intervention were found (executive function (range 0-15): intervention: 6.58, 95% CI = 6.12-7.04; control: 5.89, 95% CI = 5.45-6.33; difference -0.69, 95% CI = 1.33 to -0.06, P = .03; constructional praxis (range 0-15): intervention: 8.84, 95% CI = 8.83-9.34; control: 7.53, 95% CI = 7.04-8.01; difference -1.31, 95% CI = 2.01 to -0.61, P < .001). After adjusting for baseline constructional praxis, the group comparison was no longer significant. Average length of stay was shorter in the intervention (36.09 days) than the control (53.13 days) group (standard error = 0.15, P = .01, negative binomial regression).

Conclusion: Cognitively stimulating activities did not improve delirium but improved executive function and reduced length of stay. Resolution of delirium may require more-intense nonpharmacological management when the individual has dementia.

Keywords: delirium; dementia; nonpharmacological intervention; postacute care.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow of Primary Participants (N= 283) Through Study
Figure 2
Figure 2
Time to First Remission
Figure 3
Figure 3
Mean Delirium Severity Score
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911–922. - PMC - PubMed
    1. Fick DM, Agostini JV, Inouye SK. Delirium superimposed on dementia: A systematic review. J Am Geriatr Soc. 2002;50(10):1723–1732. - PubMed
    1. Fong TG, Jones RN, Marcantonio ER, et al. Adverse outcomes after hospitalization and delirium in persons with Alzheimer disease. Ann Intern Med. 2012;156(12):848–856. - PMC - PubMed
    1. Pandharipande PP, Girard TD, Jackson JC, et al. Long-term cognitive impairment after critical illness. N Engl J Med. 2013;369(14):1306–1316. - PMC - PubMed
    1. Mark RE, Muselaers N, Scholten H, et al. Short-term cognitive effects after recovery from a delirium in a hospitalized elderly sample. J Nerv Ment Dis. 2014;202(10):732–737. - PubMed

Publication types