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. Author manuscript; available in PMC: 2010 Mar 1.
Published in final edited form as: J Gerontol Nurs. 2009 Mar;35(3):30. doi: 10.3928/00989134-20090301-06

TABLE 2.

A NURSING RESEARCH AGENDA FOR INTERVENTIONS TO PREVENT DELIRIUM IN EARLY-STAGE ALZHEIMER’S DISEASE (AD)

Diagnosis and evaluation of delirium in early-stage AD. Need to refine and test instruments for delirium in early-stage AD. Issues to consider:

  • Assess overlapping symptoms in delirium and early-stage AD.

  • Determine factors in early nurse/provider recognition of delirium in AD.

Identify etiology/risk factors unique to delirium in early-stage AD:

  • Develop models for determining individuals with early-stage AD at highest risk.

  • Determine factors most amenable to interventions across settings.

Prevention of delirium through enhancement of cognitive reserve. Challenges to address:

  • Individualization of cognitive activities.

  • Measuring effect of education and other reserve protective effects on training.

  • Defining and measuring cognitive reserve as an active mechanism.

  • Determine components of intervention most effective.

  • Measurement of trajectory of cognitive decline over time with AD/delirium.

  • Assess delirium management strategies most effective in early-stage AD.

  • Evaluate home prevention of delirium.

Intervention methodology and design issues to consider:

  • Initiation and maintenance of treatment.

  • Short-term versus long-term effects.

  • Randomizing patients by clusters rather than as individuals using a cluster randomized controlled trial (RCT) design.

  • Dosage and duration of intervention/activities.

  • Use of functional magnetic resonance imaging and biomarkers in assessing outcomes.

Ethical issues to address:

  • Identify best methods for promoting autonomy and ensuring protection of research, both in informed consent and in the conduct of the study itself, for participants who are at risk of or are experiencing delirium.

  • Assess decisional capacity of individuals with delirium for both treatment and research consent.

  • Determine measures for obtaining the most appropriate surrogate informed consent, when necessary.

  • Assess participants’ understanding of study risk.

  • Evaluate when and how to notify clinicians of delirium in RCTs.

  • Establish postdelirium recovery information and counseling.

Translational considerations for delirium interventions in early-stage AD:

  • Kind of discipline/provider needed to best deliver intervention.

  • Best ways to facilitate adoption of intervention.

  • Use of informatics to deliver or enhance components of intervention.

  • Costing out intervention savings.

  • Financing of intervention.

  • Delivery across care settings.

  • Organizational and leadership characteristics influencing adoption of intervention.