The purpose of this study is to test the effectiveness of cognitively stimulating activities for resolving delirium in people with dementia.

The primary aim in this RCT is to test the efficacy of Recreational Stimulation for Elders as a Vehicle to resolve DSD (RESERVE- DSD). The investigators will randomize 256 subjects, newly admitted to post acute care, to intervention (RESERVE-DSD) or control (usual care). Intervention subjects will receive 30-minute sessions of tailored cognitively stimulating recreational activities for up to 30 days. The investigators hypothesize that subjects who receive RESERVE-DSD will have: decreased severity and duration of delirium; greater gains in attention, orientation, memory, abstract thinking, and executive functioning; and greater gains in physical function compared to subjects with DSD who receive usual care. The investigators will also evaluate potential moderators of intervention efficacy (lifetime of complex mental activities and APOE status). The secondary aim is to describe the costs associated with RESERVE-DSD.

Inclusion Criteria:

• presence of delirium
• mild to moderate cognitive impairments
• 65 years of age or older
• English speaking
• community-dwelling
• legally authorized representative available

Exclusion Criteria:

• severe vision or hearing problems

• diagnosis of

  1. major depression
  2. Parkinson's with Lewy Body disease
  3. Huntington's disease
  4. normal pressure hydrocephalus
  5. seizure disorder
  6. subdural hematoma
  7. head trauma
  8. known structural brain abnormalities
  9. acute CVA/stroke
  10. acute psychiatric condition

• life expectancy < 6 months