The Effect of an Early Cognitive Intervention on Global Cognition in Older Hospitalized Adults With Delirium

BACKGROUND: Delirium afflicts 17% of older emergency department (ED) patients and 25% of older hospitalized patients. This form of acute brain failure is associated with accelerated cognitive decline. We conducted a randomized controlled trial to determine whether early cognitive intervention improved 4-month global cognition in older ED patients hospitalized with delirium. METHODS: A two-site randomized controlled trial was conducted with English-speaking patients aged 65 years or older who were delirious at enrollment. Patients were excluded if they had end-stage dementia, resided in a nursing home, or were in hospice. Patients were randomized to receive a cognitive intervention within 24 h of ED presentation or usual care in a 1:2 ratio. Patients randomized to cognitive intervention received twice-daily cognitive training sessions during hospitalization and weekly cognitive rehabilitation for up to 12 weeks after hospital discharge. The primary outcome was global cognition at 4 months using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), with higher scores indicating better cognition. To determine the effect of the cognitive intervention on 4-month global cognition, proportional odds logistic regression was performed, adjusted for pre-illness dementia and function, and other confounders. Adjusted odds ratios (aORs) and their 95% confidence intervals (95% CIs) are reported. RESULTS: A total of 283 patients were randomized; 97 were randomized into the cognitive intervention arm, and 186 were randomized into the usual care arm. A total of 152 patients had 4-month RBANS data. The median interquartile range (IQR) RBANS score at 4 months was 67 (49, 80) and 67 (52, 83) in the intervention and usual care groups, respectively. In the adjusted analysis, the cognitive intervention was not significantly associated with 4-month RBANS (aOR = 0.86; 95% CI: 0.45, 1.65). CONCLUSIONS: Early cognitive intervention was not associated with improved 4-month global cognition in older ED patients hospitalized with delirium.