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

Department

Neurology

Document Type

Article

Publication Title

Journal of The American Geriatrics Society

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.

First Page

2424

Last Page

2432

DOI

10.1111/jgs.14511

Volume

64

Issue

12

Publication Date

12-1-2016

Medical Subject Headings

Aged, 80 and over; Cognitive Behavioral Therapy (methods); Delirium (complications, rehabilitation); Dementia (complications, rehabilitation); Executive Function; Female; Geriatric Assessment; Humans; Independent Living; Length of Stay; Male; Severity of Illness Index; Single-Blind Method; Subacute Care; Treatment Outcome

PubMed ID

27861718

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