Resumen de Effect of Cognitively Stimulating Activities on Symptom Management of Delirium Superimposed on Dementia: A Randomized Controlled Trial
Ann Kolanowski, Donna M. Fick, Mark Litaker, Paula Mulhall, Linda Clare, Nikki Hill, Jacqueline Mogle, Malaz Boustani, David Gill, Andrea Yevchak-Sillner
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.
