Adults with dementia and delirium may soon have a way to combat their delirium, thanks to a $2.4 million, five-year grant from the National Institutes of Health.

"Delirium is prevalent in people with dementia," said Ann Kolanowski, Elouise Ross Eberly Professor of Nursing, Penn State. "We found in our pilot study that many older adults who have dementia and experience a medical problem often develop delirium, and it doesn't necessarily resolve by the time they are discharged from the hospital."

Delirium, defined as a state of mental confusion, occurs in over half of all hospitalized older adults with dementia. If delirium continues, it can interfere with patient rehabilitation and there is a very high risk of permanent institutionalization, said Kolanowski.

The grant, from NIH's National Institute of Nursing Research, was awarded to Kolanowski and colleague Donna Fink, professor of nursing, Penn State. The researchers will test an intervention consisting of cognitive activities to help patients with delirium superimposed on dementia.

"Cognitive processing helps restore cognitive functioning," said Kolanowski. "In delirium, improved cognitive function is accompanied by improvement in physical function and resolution of delirium."

The intervention Kolanowski and colleagues propose is called Recreational Stimulation for Elders as a Vehicle to Resolve Delirium Superimposed on Dementia. It is a drug-free intervention that focuses on simple, but intellectually stimulating, recreational tasks. Each task focuses on different cognitive domains, which include memory, attention, orientation, abstract thinking and executive functioning.

"One of the more popular activities is 'finish the phrase,'" said Kolanowski, explaining a memory exercise. "So we might say something like, 'every Tom, Dick and ...' and let them finish with 'Harry.' Or 'a bird in the hand is worth ...' and they'd say 'two in a bush.'"


In addition to Kolanowski and Fink, other researchers on the grant include Paula Mulhall, project director, Penn State; Douglas Leslie, professor in public health sciences, Penn State College of Medicine; Linda Clare, professor of clinical psychology and neuropsychology, Bangor University; Mark Litaker, associate professor in general dental sciences and director of biostatistics, University of Alabama at Birmingham; Malaz Boustani, associate professor of medicine, Indiana University; and Keith Whitfield, professor of psychology and neuroscience, Duke University.

Victoria M. Indivero
Penn State