Effect of Cognitively Stimulating Activities on Symptom Management of Delirium Superimposed on Dementia: A Randomized Controlled Trial.
Effect of Cognitively Stimulating Activities on Symptom Management of Delirium Superimposed on Dementia: A Randomized Controlled Trial.
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DOI：
10.1111/jgs.14511
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发表时间：
2016-12
影响因子：
6.3
通讯作者：
Yevchak-Sillner A
中科院分区：
文献类型：
--
作者：
Kolanowski A;Fick D;Litaker M;Mulhall P;Clare L;Hill N;Mogle J;Boustani M;Gill D;Yevchak-Sillner A
谵妄在急性期后护理（PAC）痴呆患者中很常见;其治疗方法尚未确定。我们假设，认知刺激活动将减少谵妄的持续时间和严重程度，并在更大程度上改善认知和身体功能比常规护理。单盲随机临床试验。八个PAC设施。283名社区老年痴呆症和谵妄患者。每天提供认知刺激活动，最多持续30天。主要结局为谵妄持续时间（意识模糊评估方法）和谵妄严重程度（谵妄评定量表）。次要结局是认知功能（数字前进，蒙特利尔认知评估和CLOX）和身体功能（Barthel指数）。两组无谵妄天数的平均百分比相似：64.8%（95% CI：59.6-70.1）（干预组）vs. 68.7%（95% CI：63.9-73.6）（对照组），p = 0.37，Wilcoxon秩和检验。两组的谵妄严重程度相似：10.77（95% CI：10.10-11.45）（干预）vs. 11.15（95% CI：10.50-11.80）（对照），差异为0.37（95% CI：0.56-1.31，p= 0.43）。发现有利于干预的次要结局的显著差异：执行功能：6.58（95% CI：6.12-7.04）与5.89（95% CI：5.45-6.33），差异为-0.69（95% CI：1.33- −0.06，p=0.03）;结构实践：8.84（95% CI：8.83-9.34）vs. 7.53（95% CI：7.04-8.01），差异为− 1.31（95% CI：2.01- −0.61，p=0.0003）。调整基线结构实践后，组间比较不再显著。干预组的平均住院时间较短（36.09天vs. 53.13天，SE = 0.15，p = 0.01，负二项回归）。认知刺激活动并没有改善谵妄，但确实改善了执行功能并缩短了住院时间。当患者患有痴呆症时，谵妄的解决可能需要更强烈的非药物管理。
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. Single-blind randomized clinical trial. eight PAC facilities. 283 community-dwelling older adults with dementia and delirium. Cognitively-stimulating activities delivered 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 and CLOX) and physical function (Barthel Index). 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). 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.
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影响因子：
8.8
作者：
Gunther ML;Morandi A;Krauskopf E;Pandharipande P;Girard TD;Jackson JC;Thompson J;Shintani AK;Geevarghese S;Miller RR 3rd;Canonico A;Merkle K;Cannistraci CJ;Rogers BP;Gatenby JC;Heckers S;Gore JC;Hopkins RO;Ely EW;VISIONS Investigation, VISualizing Icu SurvivOrs Neuroradiological Sequelae
通讯作者：
VISIONS Investigation, VISualizing Icu SurvivOrs Neuroradiological Sequelae
影响因子：
3.4
作者：
Kolanowski, Ann M.;Fick, Donna M.;Gill, David J.
通讯作者：
Gill, David J.
影响因子：
39
作者：
Hshieh, Tammy T.;Yue, Jirong;Oh, Esther;Puelle, Margaret;Dowal, Sarah;Travison, Thomas;Inouye, Sharon K.
通讯作者：
Inouye, Sharon K.
影响因子：
168.9
作者：
Inouye, Sharon K.;Westendorp, Rudi G. J.;Saczynski, Jane S.
通讯作者：
Saczynski, Jane S.
DOI：
10.1111/j.1532-5415.2011.03595.x
发表时间：
2011-10-01
影响因子：
6.3
作者：
Cole, Martin G.;McCusker, Jane;Belzile, Eric
通讯作者：
Belzile, Eric