title: Effect of Cognitively Stimulating Activities on Symptom Management of Delirium Superimposed on Dementia: A Randomized Controlled Trial.
abstract: 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.
  
  
  
  Single-blind randomized clinical trial.
  
  
  
  Eight post-acute care (PAC) facilities.
  
  
  
  Community-dwelling older adults with dementia and delirium (N = 283).
  
  
  
  Research staff provided cognitively stimulating activities daily for up to 30 days.
  
  
  
  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).
  
  
  
  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).
  
  
  
  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.
authors.affiliation: College of Nursing, Pennsylvania State University, University Park, Pennsylvania.
authors.forename: Ann
authors.initials: A
authors.lastname: Kolanowski
authors.affiliation: College of Nursing, Pennsylvania State University, University Park, Pennsylvania.
authors.forename: Donna
authors.initials: D
authors.lastname: Fick
authors.affiliation: School of Dentistry, University of Alabama, Birmingham, Alabama.
authors.forename: Mark
authors.initials: M
authors.lastname: Litaker
authors.affiliation: Prevention Research Center, College of Health and Human Development, Pennsylvania State University, University Park, Pennsylvania.
authors.forename: Paula
authors.initials: P
authors.lastname: Mulhall
authors.affiliation: Centre for Research in Ageing and Cognitive Health, Washington Singer Laboratories, Exeter, United Kingdom.
authors.forename: Linda
authors.initials: L
authors.lastname: Clare
authors.affiliation: College of Nursing, Pennsylvania State University, University Park, Pennsylvania.
authors.forename: Nikki
authors.identifier: 0000-0002-9014-7051
authors.initials: N
authors.lastname: Hill
authors.affiliation: College of Nursing, Pennsylvania State University, University Park, Pennsylvania.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Mogle
authors.affiliation: School of Medicine and Aging Brain Center, Indiana University, Indianapolis, Indiana.
authors.forename: Malaz
authors.initials: M
authors.lastname: Boustani
authors.affiliation: Rochester Regional Health, University of Rochester, Rochester, New York.|Department of Neurology, University of Rochester, Rochester, New York.
authors.forename: David
authors.initials: D
authors.lastname: Gill
authors.affiliation: College of Nursing, Pennsylvania State University, University Park, Pennsylvania.
authors.forename: Andrea
authors.initials: A
authors.lastname: Yevchak-Sillner
mesh_terms: D000369:Aged, 80 and over; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003693:Delirium / Q000150:complications / Q000534:rehabilitation*; D003704:Dementia / Q000150:complications / Q000534:rehabilitation*; D056344:Executive Function; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D057187:Independent Living; D007902:Length of Stay; D008297:Male; D012720:Severity of Illness Index; D016037:Single-Blind Method; D019467:Subacute Care; D016896:Treatment Outcome
keywords: delirium; dementia; nonpharmacological intervention; postacute care