An intervention for delirium superimposed on dementia based on cognitive reserve theory
An intervention for delirium superimposed on dementia based on cognitive reserve theory
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DOI：
10.1080/13607860903167853
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发表时间：
2010-01-01
影响因子：
3.4
通讯作者：
Gill, David J.
中科院分区：
文献类型：
--
作者：
Kolanowski, Ann M.;Fick, Donna M.;Gill, David J.
谵妄叠加痴呆（DSD）加速了功能下降的轨迹，并导致住院时间延长，再住院，过早的疗养院安置和死亡。在这篇文章中，我们提出了一个基于理论的干预DSD是来自认知储备和神经可塑性的文献。我们开始定义认知储备，我们的假设的指导框架。我们回顾了谵妄的病理生理学和神经心理学，注意到与痴呆的相似之处-这两种情况分别反映了认知储备的急性和慢性减少。然后，我们回顾了活动依赖性可塑性的证据，作为一种可能的机制，节省认知储备在痴呆症和其解决DSD的潜力。认知训练（CT）的形式，刺激活动已被证明可以唤起认知加工和促进可塑性痴呆。由于痴呆症和谵妄之间的相似性，使用娱乐活动作为支持注意力能力的载体，并提供认知刺激，可能有望解决DSD。基于文献中的综合证据，我们假设参与认知刺激的娱乐活动将有助于降低痴呆患者的谵妄严重程度和持续时间，同时提高生活质量并降低护理成本。
Delirium superimposed on dementia (DSD) accelerates the trajectory of functional decline and results in prolonged hospitalization, re-hospitalization, premature nursing home placement, and death. In this article we propose a theory-based intervention for DSD that is derived from the literature on cognitive reserve and neuroplasticity. We begin by defining cognitive reserve, the guiding framework for our hypothesis. We review the pathophysiology and neuropsychology of delirium noting the similarities with dementia - these two conditions reflecting acute and chronic reductions in cognitive reserve, respectively. We then review the evidence for activity-dependent plasticity as a possible mechanism for sparing cognitive reserve in dementia and its potential for addressing DSD. Cognitive training (CT) in the form of stimulating activities has been shown to evoke cognitive processing and facilitate plasticity in dementia. Because of the similarities between dementia and delirium, the use of recreational activities as a vehicle for supporting attentional capacity, and delivering cognitive stimulation, may hold promise for the resolution of DSD. Based on integrated evidence from the literature, we hypothesize that engagement in cognitively stimulating recreational activities will help reduce delirium severity and duration in persons with dementia while providing improved quality of life and reduced costs of care.