Personality as a Moderator of Cognitive Stimulation Outcomes in Older Adults at High Risk for Cognitive Decline
Open Access
- Author:
- Hill, Nikki Lynn
- Graduate Program:
- Nursing
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- June 07, 2013
- Committee Members:
- Ann Marie Kolanowski, Committee Chair/Co-Chair
Donna Marie Fick, Committee Member
Vernon Michael Chinchilli, Committee Member
Rita Jablonski, Committee Member - Keywords:
- dementia
delirium
personality
moderators
cognitive interventions - Abstract:
- Background: Individuals with dementia and delirium experience an accelerated period of cognitive decline which is often unresolved, leading to long-term negative consequences. Interventions targeting acute cognitive decline in this population are largely unexplored, and moderators of intervention effectiveness have yet to be determined. Purpose: The purpose of this study was to determine whether personality moderated cognition-focused intervention outcomes in individuals at high risk for cognitive decline: those with dementia and delirium. Methods: This study utilized a portion (n=71) of the sample participating in a randomized repeated measures clinical trial, Recreational Stimulation for Elders as a Vehicle to Resolve Delirium Superimposed on Dementia (RESERVE-DSD). Subjects with dementia and concurrent delirium were recruited upon admission to one of seven Pennsylvania nursing homes with post-acute services for rehabilitation following hospitalization; all diagnoses were adjudicated by an expert panel. The control group received routine nursing care and prescribed therapies as typically delivered for their particular health condition. In addition to usual care, subjects randomized to the treatment group received 30 minutes of cognitive stimulation daily for up to 30 days. The intervention consisted of personally tailored, mentally challenging recreational activities that incrementally increased in difficulty. Baseline measures included demographic characteristics, ApoE ε4 status, Lifetime of Experiences Questionnaire, the Modified Blessed Dementia Rating Scale, and the NEO™ Personality Inventory-3. Measures of delirium, attention, orientation, memory, and executive function were taken daily for both groups. Engagement in the intervention was measured by the time spent on task (up to 30 minutes) as well as the level of participation. Linear mixed-effects models were used to examine the moderating effects of the five personality traits on the four cognitive outcomes, as well as main effects on engagement outcomes among the treatment group. Results: Significant moderating effects of personality traits were found with regard to two cognitive outcomes: agreeableness moderated the memory outcome and extraversion moderated the executive function outcome. Individuals with higher agreeableness were more likely to have improved memory outcomes, and those with lower extraversion more likely to have improved executive function outcomes, as a result of the cognition-focused intervention. Lower openness, higher agreeableness, and lower conscientiousness were associated with greater engagement in the intervention. Conclusion: Personality traits are known to influence a wide variety of health and treatment outcomes, and their role in cognition-focused interventions for individuals with dementia and delirium is in line with these findings. The consideration of personality in further development and testing of these interventions will provide for clarification and characterization of these effects.