Effect of cognitively stimulating activities on symptom management of delirium superimposed on dementia: A randomized controlled trial
Open accessAbstract
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.
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Risk factors for delirium in dementia include sensory impairment, pain, polypharmacy, dehydration, intercurrent illnesses such as urinary tract infections or faecal impaction, and an unfamiliar or changing environment.
“Risk factors for delirium in dementia include sensory impairment, pain, polypharmacy, dehydration, intercurrent illnesses, such as urinary tract infections or faecal impaction, and an unfamiliar or changing environment.286”
From Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (2020) · cites this paper as [286]
The Introduction (page unavailable) says that delirium risk factors can be modified, but does not identify the factors listed in the claim. Searches for dehydration, infection, faecal impaction, polypharmacy, sensory impairment, and environmental change found no passage in our copy that establishes this list as risk factors for delirium in dementia. (LLM, conf=0.76)
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Montgomery, A., Campbell, K., Roberts, S., Nitchingham, A., Marriott‐Statham, K., D'Cunha, N. M., & Agar, M. R. (2026) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2026.106420
- Authors
- Kolanowski, A., Fick, D., Litaker, M., Mulhall, P., Clare, L., Hill, N., Mogle, J., Boustani, M., Gill, D., & Yevchak‐Sillner, A.
- Affiliations
- Pennsylvania State University (US)
- University of Alabama (US)
- Centre for Research in Ageing and Cognitive Health Washington Singer Laboratories Exeter United Kingdom
- Indiana University Indianapolis (US)
- University of Rochester Medicine (US)
- Corresponding author
- Kolanowski, Ann
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2016-11-12
- Volume
- 64
- Issue
- 12
- Pages
- 2424-2432
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC5173415
- OpenAlex
- W2555962087
- Cited by
- 40
- References
- 46
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 4 · 2023: 3 · 2022: 3 · 2021: 5 · 2020: 7 · 2019: 4 · 2018: 3 · 2017: 2 · 2016: 2
- FWCI
- 3.33
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- Funders
- National Institute of Nursing Research (R01NR012242)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Keywords
- delirium, dementia, cognitively stimulating activities, delirium management, executive function, physical function, post-acute care, community-dwelling older adults, cognitive function, praxis, postural control, postural sway, postural stability
- MeSH terms
- Aged, 80 and over, Delirium, Dementia, Female, Humans, Length of Stay, Male, Severity of Illness Index, Geriatric Assessment, Cognitive Behavioral Therapy, Single-Blind Method, Treatment Outcome, Subacute Care, Executive Function, Independent Living
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