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

Abstract

Background Delirium is common in post-acute care (PAC) patients with dementia; its treatment is not established. We hypothesized that cognitively-stimulating activities would reduce the 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 PAC facilities.

Participants 283 community-dwelling older adults with dementia and delirium.

Intervention Cognitively-stimulating activities delivered 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 and CLOX) and physical function (Barthel Index).

Results Mean percentage of delirium-free days were similar in both groups: 64.8% (95% CI: 59.6–70.1) (intervention) vs. 68.7% (95% CI: 63.9–73.6) (control), p = 0.37, Wilcoxon's rank sums test. Delirium severity was similar in both groups: 10.77 (95% CI: 10.10–11.45) (intervention) vs. 11.15 (95% CI: 10.50–11.80) (control), a difference of 0.37 (95% CI: 0.56–1.31, p= 0.43). Significant differences for secondary outcomes favoring intervention were found: executive function: 6.58 (95% CI: 6.12–7.04) vs. 5.89 (95% CI: 5.45–6.33), a difference of −0.69 (95% CI: 1.33– −0.06, p=0.03); and constructional praxis: 8.84 (95% CI: 8.83–9.34) vs. 7.53 (95% CI: 7.04–8.01), a difference of − 1.31 (95% CI: 2.01– −0.61, p=0.0003). After adjusting for baseline constructional praxis the group comparison was no longer significant. Average length of stay was shorter in intervention (36.09 days vs. 53.13 days, SE = 0.15, p = 0.01, negative binomial regression).

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