An Examination of Cognitive Trajectories in Post-Acute Delirium Superimposed on Dementia
Restricted (Penn State Only)
- Author:
- Arendacs, Rachel
- Graduate Program:
- Nursing
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- May 05, 2022
- Committee Members:
- Lisa Kitko, Program Head/Chair
Susan Loeb, Major Field Member
Vernon Chinchilli, Outside Unit & Field Member
Ann Kolanowski, Special Member
Marie Boltz, Chair & Dissertation Advisor
Donna Fick, Major Field Member - Keywords:
- cognitive function
dementia
delirium
dementia superimposed on delirium
post-acute care - Abstract:
- Background: Delirium superimposed on dementia (DSD) accelerates the clinical course and trajectory of cognitive decline and is associated with worsening healthcare outcomes. The natural course of cognitive changes in DSD, the factors that influence those changes, and the impact of cognition upon physical function, remain largely unknown. An understanding of these phenomena would inform the development of targeted nursing assessments and interventions to support cognitive symptom abatement and functional recovery. Purpose: The purpose was to explore the trajectory of cognitive function in older adults with DSD admitted to skilled nursing facilities (SNFs) from the hospital. This study aimed to: 1) examine the trajectory of the cognitive domains of attention, memory, orientation, and executive function over the initial 14-day period; 2) examine the influence of patient characteristics (age, gender, race, educational level, comorbidity, ApoE status, dementia severity, delirium symptoms severity, anticholinergic burden, pain intensity, and therapy participation) upon the cognitive function domains of attention, memory, orientation, and executive function; and 3) examine the influence of each cognitive domain upon physical function over a 14-day period, while controlling for patient characteristics. Methods: Data (N = 139) collected from a randomized clinical trial, Recreational Stimulation for Elders as a Vehicle to Resolve Delirium Superimposed on Dementia (RESERVE- DSD) was included. Hierarchical, longitudinal data for Aim 1 and Aim 2 were analyzed with linear-mixed effect modeling. Regression models were conducted for Aim 3. Results: Performance in memory, orientation, and executive function decreased as delirium severity increased, whereas attention scores were stable across days. Delirium severity had the most consistent associations with all cognitive domains at both within- and between-person levels. Older age (β = 0.078, SE = 0.034, p = .0376) and higher education (β = 0.1085, SE = 0.049, p = .0285) was associated with higher attention. Cognitive domains were not associated with physical functioning; however worse daily physical functioning was associated with higher pain severity (β = -0.3769, SE = 0.1750, p =.0334), more severe delirium symptoms (β = -1.389, SE = 0.6434, p =.0328), having hypoactive delirium (β = -1.1978, SE = 0.4029, p =.0033), and being older (β = -0.07541, SE = 0.03117, p =.0173). Conclusions: The association of delirium severity with impairment in memory, orientation, and executive function persisted up to fourteen days, underscoring the need for ongoing cognitive assessment of persons with DSD in post-acute care. Recommendations for future research include a more nuanced assessment of attention and an examination of the potential moderating/mediating effect of education level upon delirium outcomes. Pain, the presence of hypoactive delirium, and delirium severity should be considered when developing a plan for functional recovery in the resident with DSD admitted to the SNF post-hospitalization.