Long-term Care Units Research Articles

Behavioral Pain Assessment Implementation in Long-Term Care Using a Tablet App: Case Series and Quasi-Experimental Design.

BackgroundPain is often underassessed and undertreated among long-term care (LTC) residents living with dementia. When used regularly, the Pain Assessment Checklist for Seniors With Limited Ability to Communicate (PACSLAC) scales have been shown to have beneficial effects on pain assessment and management practices and stress and burnout levels in frontline staff in LTC facilities. Such scales, however, are not utilized as often as recommended, which is likely to be related to additional record-keeping and tracking over time involved with their paper-and-pencil administration.ObjectiveUsing implementation science principles, we assessed the introduction of the PACSLAC-II scale by comparing two methods of administration—a newly developed tablet app version and the original paper-and-pencil version—with respect to the frequency of pain assessment and facility staff feedback.MethodsUsing a case series approach, we tracked pain-related quality indicators at baseline, implementation, and follow-up periods. A quasi-experimental design was used to evaluate the effect of the method of administration (ie, paper-and-pencil only [n=18], tablet only [n=12], paper-and-pencil followed by tablet app [n=31], and tablet app followed by paper-and-pencil [n=31]) on pain assessment frequency and frontline staff stress and burnout levels. Finally, semistructured interviews were conducted with frontline staff to obtain perspectives on each method of administration.ResultsThe implementation effort resulted in a great increase in pain assessment frequency across 7 independent LTC units, although these increases were not maintained during the follow-up period. Frontline staff reported lower levels of workload in the paper-and-pencil followed by tablet app condition than those in the paper-and-pencil only (P<.001) and tablet app followed by paper-and-pencil (P<.001) conditions. Frontline staff also reported lower levels of workload in the tablet-only condition than those in the paper-and-pencil only condition (P=.05). Similarly, lower levels of emotional exhaustion were reported by frontline staff in the paper-and-pencil followed by tablet app condition than those in the paper-and-pencil only (P=.002) and tablet app followed by paper-and-pencil (P=.002) conditions. Finally, frontline staff reported higher levels of depersonalization in the paper-and-pencil only condition than those in the tablet app only (P=.008), paper-and-pencil followed by tablet app (P<.001), and tablet app followed by paper-and-pencil (P<.001) conditions. Furthermore, narrative data from individual interviews with frontline staff revealed a preference for the tablet app over the paper-and-pencil method of administration.ConclusionsThis study provides support for the use of either the tablet app or the paper-and-pencil version of the PACSLAC-II to improve pain-related quality indicators, but a reported preference for and lower levels of stress and burnout with the use of the tablet app method of administration suggests that the use of the tablet app may have more advantages compared with the paper-and-pencil method of administration.

Co-production between long-term care units and voluntary organisations in Norwegian municipalities: a theoretical discussion and empirical analysis

In Norway, due to demographic challenges with an ageing population and lower fertility rates, current government policies have encouraged municipalities and volunteers to collaborate. Moreover, present policies recommend an increase in volunteer activities within care services. Co-production is advocated as a functional and innovative method of activating resources when citizens and public employees interact in the care sector. This study has scrutinised ongoing volunteer activities in nursing homes and home care facilities by utilising the results from a survey targeting employees in public care services. The aim has been to identify the extent to which long-term care units (LTC units) in Norwegian municipalities and voluntary organisations collaborate in the coordination of volunteer activities at the local level by answering the following research questions: when LTC units and voluntary organisations collaborate in coordinating voluntary activities within caring services: are they sharing tasks, dividing the tasks between them or both? The results show that LTC units often coordinate volunteer activities that correspond to statutory public care services. Additionally, LTC units also contribute considerably in coordinating other volunteer activities, either alone or to a small extent in collaboration with voluntary organisations. This limited task sharing when coordinating volunteer activities in municipal care services can be seen as a suboptimal way of using the resources. Hence, a large part of this paper concerns a discussion of the theory of co-production in public care services, drawing on the findings of the survey.

Assessing causes of alarm fatigue in long-term acute care and its impact on identifying clinical changes in patient conditions

Abstract Physiologic alarms are an important modality in the care of critically ill patients. Yet the many electronic devices used in patient care and the combination of alarms can cause sensory overload in caregivers. This sensory overload can lead to monitor fatigue, and caregivers may miss critical alarms, which can be fatal for patients. Many factors not related to a change in patients' condition can be directly linked to desensitization and alarm fatigue, leading to a failure to recognize or attend to true instability in spite of the alarm. Research demonstrates that the majority of alarms are non-actionable, and staff can develop alarm fatigue trying to determine which alarms are valid and which are not. We postulate that more experience detecting false alarms among professionals in a long-term acute care unit will lead to improved clinical changes and better survival rates among patients. Our proportional hazards model relates missing clinical changes in patients' condition as time passes, after reduced attention to false alarms, to professional experience. In our proportional hazards model, the unique effect of a unit increase in a covariate is multiplicative with respect to the hazard rate. Therefore, reduced attention to false alarms by experienced professionals decreases the hazard rate for missing a clinical change. We use survival analyses, the hazard function, the receiver-operating characteristic curve, and the Hosmer-Lemeshow test to support our conclusions. Our results show that monitoring equipment is instrumental in alerting staff in a long-term care unit to serious changes in patients’ condition and in preventing false positives and false negatives.

Acceptability and Feasibility of a Multicomponent Telehealth Care Management Program in Older Adults With Advanced Dementia in a Residential Memory Care Unit.

The aim of the current study was to examine the acceptability and feasibility of a multicomponent care management program in older adults with advanced dementia in a long-term memory care unit. Eighteen older adults with moderate to severe dementia were asked to wear an activity monitor (Fitbit Charge 2 HR) and participate in a once monthly telehealth intervention via iPads over a 6-month period. Activity monitor data were used to assess compliance. Acceptability was assessed through qualitative interviews conducted with the caregiving staff on the memory unit. The care management program was acceptable to residents and their caregivers. Results indicated that the care management program is feasible in older adults with advanced dementia although activity monitor adherence was better during the day than at night. Telehealth session compliance was excellent throughout the study. A long-term multicomponent dementia care program is acceptable and feasible in individuals with advanced dementia. Future studies should aim to evaluate whether data received from activity monitors can be used in a dementia care intervention program.

Identifying the long-term care beneficiaries: differences between risk factors of nursing homes and community-based services admissions.

The Portuguese long-term care sector is classified into home and community-based services (HCBS) and three nursing home (NH) units: convalescence, medium term and rehabilitation, and long term and maintenance. To identify the main factors of admission into each care setting and explore to what extent these populations are different. 14,140 patients from NH and 6844 from HCBS were included from all over the country. A logistic regression was estimated to identify determinants of admission into NH care, using sociodemographic characteristics, medical conditions and dependence levels at admission as independent variables, and region of care, referral entity and placement process as control variables. Then, ordered logistic regression was used to identify the contribution of the above factors in each specific NH unit. Being female, not being married, not having family/neighbour support, being literate, having mental illness, being cognitively or physically impaired are the main predictors of being admitted into a NH. Within the NH units, placements of the large majority of patients were accurately predicted, based on the available variables. However, for around half of the patients referred to long-term care units, the model expected placements into medium-term units, while for those admitted into short-stay units, the model returned that 29% could have benefited from being admitted into a medium-term care unit. Patients' accurate placement is a highly complex and challenging process, demanding more variables than the ones available for the model here presented. Our work confirms the need to collect other type of variables to improve the placement decision process.

Antimicrobial-resistant pathogens associated with adult healthcare-associated infections: Summary of data reported to the National Healthcare Safety Network, 2015-2017.

Describe common pathogens and antimicrobial resistance patterns for healthcare-associated infections (HAIs) that occurred during 2015-2017 and were reported to the Centers for Disease Control and Prevention's (CDC's) National Healthcare Safety Network (NHSN). Data from central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), and surgical site infections (SSIs) were reported from acute-care hospitals, long-term acute-care hospitals, and inpatient rehabilitation facilities. This analysis included device-associated HAIs reported from adult location types, and SSIs among patients ≥18 years old. Percentages of pathogens with nonsusceptibility (%NS) to selected antimicrobials were calculated for each HAI type, location type, surgical category, and surgical wound closure technique. Overall, 5,626 facilities performed adult HAI surveillance during this period, most of which were general acute-care hospitals with <200 beds. Escherichia coli (18%), Staphylococcus aureus (12%), and Klebsiella spp (9%) were the 3 most frequently reported pathogens. Pathogens varied by HAI and location type, with oncology units having a distinct pathogen distribution compared to other settings. The %NS for most pathogens was significantly higher among device-associated HAIs than SSIs. In addition, pathogens from long-term acute-care hospitals had a significantly higher %NS than those from general hospital wards. This report provides an updated national summary of pathogen distributions and antimicrobial resistance among select HAIs and pathogens, stratified by several factors. These data underscore the importance of tracking antimicrobial resistance, particularly in vulnerable populations such as long-term acute-care hospitals and intensive care units.

Characteristic Differences between Actionable and Non-Actionable True Ventricular Tachycardia Alarms

Physiologic alarms are an important modality in the care of critically ill patients. Yet the many electronic devices used in patient care and the combination of alarms can cause sensory overload in caregivers. This sensory overload can lead to monitor fatigue, and caregivers may miss critical alarms, which can be fatal for patients. Many factors not related to a change in patients' condition can be directly linked to desensitization and alarm fatigue, leading to a failure to recognize or attend to true instability in spite of the alarm. Research demonstrates that the majority of alarms are non-actionable, and staff can develop alarm fatigue trying to determine which alarms are valid and which are not. We postulate that more experience detecting false alarms among professionals in a long-term acute care unit will lead to improved clinical changes and better survival rates among patients. Our proportional hazards model relates missing clinical changes in patients' condition as time passes, after reduced attention to false alarms, to professional experience. In our proportional hazards model, the unique effect of a unit increase in a covariate is multiplicative with respect to the hazard rate. Therefore, reduced attention to false alarms by experienced professionals decreases the hazard rate for missing a clinical change. We use survival analyses, the hazard function, the receiver-operating characteristic curve, and the Hosmer-Lemeshow test to support our conclusions. Our results show that monitoring equipment is instrumental in alerting staff in a long-term care unit to serious changes in patients’ condition and in preventing false positives and false negatives.

Improving Care for Patients with Dementia: What to Do Before, During, and After a Transition

Improving Care for Patients with Dementia: What to Do Before, During, and After a Transition

The securitisation of dementia: socialities of securitisation on secure dementia care units

AbstractNearly 50 million people around the world live with dementia, with statistics predicting a steady increase in prevalence for the foreseeable future. There is a need for comprehensive and compassionate dementia care. Long-term care homes have built special care units for people living with middle- to late-stage dementia. Among other services, these care units often use innovative security technologies that monitor and curtail movement beyond unit exit doors. As care-givers and technology developers grapple with the ethical dilemma of autonomy and risk management, researchers are beginning to investigate the social impact of these security technologies. The present research contributes to this line of inquiry. Fieldwork was carried out on two secure long-term care units for people living with dementia. Ethnographic accounts will illustrate how security technology creates socialities of securitisation on a secure dementia unit. Using securitisation theory, I will argue that dementia has been redefined, shifting it from a health issue to a security issue. The discursive construction of dementia as a security issue will be considered in terms of the co-constructed notions of vulnerability, risk, security threat and security challenge with respect to people living with dementia. The paper investigates how securitisation influences the ethics of dementia care.

Teamwork and safety climate affect antimicrobial stewardship for asymptomatic bacteriuria.

In preparation for a multisite antibiotic stewardship intervention, we assessed knowledge and attitudes toward management of asymptomatic bacteriuria (ASB) plus teamwork and safety climate among providers, nurses, and clinical nurse assistants (CNAs). Prospective surveys during January-June 2018. All acute and long-term care units of 4 Veterans' Affairs facilities. The survey instrument included 2 previously tested subcomponents: the Kicking CAUTI survey (ASB knowledge and attitudes) and the Safety Attitudes Questionnaire (SAQ). A total of 534 surveys were completed, with an overall response rate of 65%. Cognitive biases impacting management of ASB were identified. For example, providers presented with a case scenario of an asymptomatic patient with a positive urine culture were more likely to give antibiotics if the organism was resistant to antibiotics. Additionally, more than 80% of both nurses and CNAs indicated that foul smell is an appropriate indication for a urine culture. We found significant interprofessional differences in teamwork and safety climate (defined as attitudes about issues relevant to patient safety), with CNAs having highest scores and resident physicians having the lowest scores on self-reported perceptions of teamwork and safety climates (P &lt; .001). Among providers, higher safety-climate scores were significantly associated with appropriate risk perceptions related to ASB, whereas social norms concerning ASB management were correlated with higher teamwork climate ratings. Our survey revealed substantial misunderstanding regarding management of ASB among providers, nurses, and CNAs. Educating and empowering these professionals to discourage unnecessary urine culturing and inappropriate antibiotic use will be key components of antibiotic stewardship efforts.

SUN-322 COMPARISON OF DIFFERENT GLOMERULAR FILTRATION RATE FORMULAS IN CHRONIC CRITICALLY ILL PATIENTS

Even as an attention focuses on chronic critical illness increasingly, we are missing evidence-based data about effective methods of treatmet in many particular areas. Up to date, there is no information available, how to monitor kidney function in long-term critical care unit correctly. These patients are characterized by loss of muscle mass, increase of adiposity, and anasarca. Chronic stabile course of illness is interupted by episodes of acute worsening, e.g. by sepsis. Aim of our work is to compare three different creatinine based estimations of glomerular filtration rate (eGFR): CKD-EPI, MDRD 4 parameters, and MDRD 6 parameters with eGFR based on cystatin C (CKD-EPI cystatin) in patients with chronic critical illness.

Changes in antibiotic use following implementation of a telehealth stewardship pilot program.

Starting in 2016, we initiated a pilot tele-antibiotic stewardship program at 2 rural Veterans Affairs medical centers (VAMCs). Antibiotic days of therapy decreased significantly (P&lt;.05) in the acute and long-term care units at both intervention sites, suggesting that tele-stewardship can effectively support antibiotic stewardship practices in rural VAMCs.

Implementing a novel strategy for interprofessional medication review using collegial mentoring and systematic clinical evaluation in nursing homes (COSMOS)

BackgroundMultimorbid patients in nursing homes are prescribed long lists of medication, often without sufficient clinical evaluations beforehand. This results in poor clinical effects of the prescribed medication and significant side-effects, especially in patients with impaired cognition. The aim of this paper is to describe the process, content and implementation of a clinical medication review encompassing clinical testing and collegial support to prescribers.MethodsThe implementation process of a novel approach to medication review in nursing homes was logged thoroughly by structured staff feedback. Staff experienced promotors and barriers to implementation also were collected. The study was part of a cluster randomized controlled trial, in which 36 long-term care units received the COSMOS intervention. Nurses and physicians randomized to the intervention group participated in educational programs, training in clinical evaluation of the patients, and interprofessional medication review with collegial mentoring.ResultsThe intervention group contained 297 patients from 36 nursing home units. There were 105 staff attendees for the education program. The units were served by 21 different physicians. Clinical medication reviews were performed in all units and all patients were assessed prior to the medication reviews. Of the 240 patients with a logged intervention process, 220 (92%) underwent a medication review. The intervention generated enthusiasm and improved communication among nursing staff and between nursing staff and physicians. The interprofessional discussions helped to facilitate difficult decisions pertaining to treatment levels. Reported barriers were lack of time, low engagement of all nursing staff and physicians, and ethical dilemmas.ConclusionsClinical medication reviews were implemented for almost all patients, and every patient was systematically assessed prior to the medication review. The physicians perceived collegial mentoring as an asset, learning from each other facilitated decision making in terms of difficult aspects of prescribing. Knowledge about barriers and promotors can improve implementation of similar interventions in other nursing homes.Trial registrationClinicaltrials.gov (NCT02238652). Registered July 7th 2014.

Interest and interpretation of hair analysis in mistreatment of hospitalized older people

To identify the cause of the disappearance of some psychotropic drugs in the pharmacy of a geriatric long-term care unit. From July 2017, many cases of missing drugs were reported by the day nurse of one geriatric long-term care unit, including midazolam vials while no patient had such a prescription. A misuse by an unidentified nurse was suspected. In order to exclude mistreatment, 31 blood samples were taken without the knowledge of the staff during the first week of November 2017 at the end of the night care in the 7 patients with the most frequent agitation crisis. Given the results, it was proposed to perform a hair testing in 5 of those patients. After strengthened safety measures to the dispensation of benzodiazepines in the unit, a second blood testing was conducted in February 2018 in 18 patients from two adjacent geriatric units. Hair testing was also performed in March and October 2018 to evaluate the evolution. Segmental hair analysis was performed when the length of the lock allowed it (≥ 3 cm). After decontamination and liquid/liquid extraction, screening and quantification of psychotropic drugs (anxiolytics, antidepressants, hypnotics, antiepileptics, opioids, other sedatives) were performed by triple quadrupole TSQ Endura (Thermofisher ® ). In the first blood analysis, one of the 7 patients was found positive for midazolam (0.9 ng/mL) and OH-midazolam (0.6 ng/mL). This patient was found initially negative with a TSQ Access MAX triple quadripole (Thermofisher ® ), significantly less sensitive than the TSQ Endura, showing the interest of sensitive devices in these cases of mistreatment. According to this result showing the administration of a non-prescribed molecule in this patient, hair testing performed in 5 of those patients showed the presence of non-prescribed midazolam in 3 of them. The concentrations were very low for 2 (between 1 and 5 pg/mg) probably in accordance with single administration and was found higher for the 3rd in accordance with more regular administration (40 to 120 pg/mg). Were also found zolpidem (4 times), carbamazepine (4), clobazam (3), lamotrigine (2), tramadol (2), nefopam (2), zopiclone (1), alprazolam (1), levetiracetam (1), citalopram (1), venlafaxine (1), codeine (1), each patient having between 2 to 9 non-prescribed molecules in his hair. From the 18 blood samples analyzed 3 months later in February 2018, 3 were still positive to a non-prescribed medicine, 1 zopiclone (while this molecule was no longer available in the unit), 1 clobazam (not available) and 1 paroxetine (still available for the nurse staff). The second hair analysis performed in March 2018 on the 5 same patients analyzed in November showed the disappearance of all the benzodiazepines and “Z-drugs” (midazolam, alprazolam, zolpidem, zopiclone) except clobazam present in 2 patients (already present in November, both with decreased concentrations). Carbamazepine (4), lamotrigine (1) and levetiracetam (1 but not the same patient than in November) were still present and two antidepressants appeared [mirtazapine (2), venlafaxine (1), both at low concentrations], with a possibility of administration mistake since patients in the same room received these treatments. After reporting to the prosecutor, press conference carried out by the general manager of the AP–HP to secure the delivery of all psychotropic drugs in the geriatric departments of our Institution, and suspension of a suspected nurse, the 19 patients collected in October 2018 for the third hair analysis showed the absence of non-prescribed psychoactive molecules in the 1 or 2-cm proximal segment, analyzed to avoid any radial diffusion of molecules from distal segment in these very elderly subjects. This study shows the interest of a very sensitive toxicological analysis and the reliability of hair testing in these cases of hospital mistreatment, although its interpretation can be delicate considering possibility of drug administration mistakes.

A Quality Improvement Project Using Fall Management Clinical Algorithms in a Long-Term Care Unit

Falls have been an ongoing and reportable problem in long-term care (LTC) facilities. Moreover, falls can lead to serious physical, psychological and financial consequences for residents, their families and the staff. Each resident has individual risk factors for falling. Multifactorial interventions, or strategies that target multiple risk factors for falls, have been shown to reduce the number of falls and are recommended for fall prevention and management. The initial step in fall prevention and management includes identifying each resident's risk factors upon admission into the facility and after each fall.

Abstracts of the German Congress on Parkinson\u2019s Disease and Movement Disorders (Deutscher Kongress f\xfcr Parkinson und Bewegungsst\xf6rungen), 7\u20139 March 2019, D\xfcsseldorf, Germany

Background While the efficacy of cognitive stimulation (CS) has been demonstrated in patients with dementia, no study has included patients with Parkinson's disease dementia (PDD). Objective For the first time, this randomized crossover pilot study examined the feasibility and potential effects of CS in PDD. Methods All residents of a PDD-specific long-term care unit in the Netherlands that were eligible for the study (n=12) were randomly allocated to group A (n=6) receiving CS (eight weeks, twice weekly for 60 minutes) or group B (n=6) receiving usual care (control group, CG). The CG participated in CS afterwards, resulting in an experimental group (EG), consisting of n=12. Pre- and postassessments and a six-week follow-up (FU) were conducted for cognition, neuropsychiatric symptoms, quality of life (QoL), and activities of daily living (ADL) outcomes. Results Between-group analysis with difference scores from pre- to posttest revealed a group difference for global cognition (CERAD total score) favoring the EG, with a moderate effect size and a p value just failing to reach statistical significance (p=0.067; r = 0.43). A further statistical trend was observed for neuropsychiatric symptoms, again with a moderate effect size (p=0.075; r = 0.42). Within-group analyses indicated improvement only in the EG with large effects also just failing to reach significance for global cognition (short term, p=0.060; r = 0.70) as well as for depression (long term, p=0.072; r = 0.61). ADL deteriorated significantly at FU in the EG (p=0.014; r = 0.71). Conclusions Although our data are preliminary due to the small sample size, this study shows that CS is feasible and potentially effective for cognitive and noncognitive outcomes in PDD patients. Randomized controlled trials with larger sample sizes are needed to confirm these promising results.

Implementation and Outcomes of Oral Care Screening in a Skilled Nursing Facility: Examining Readmission Risk and Patient Care

Poor oral hygiene is a significant risk factor for pneumonia, and dysphagia compounds the risk. This study investigates oral hygiene assessments and hospital readmission, how oral hygiene differs in short-term and long-term care units, the effect of independence in oral care, and the difference in oral hygiene quality in patients with and without dysphagia. Participants were from a combined subacute rehabilitation and long-term care skilled nursing facility. Patients with dysphagia had significantly lower oral hygiene scores. Patients dependent on staff for oral care had significantly lower oral hygiene scores compared with patients who independently performed oral care. No significant difference in oral hygiene scores was found between short-term care and long-term care units. Education regarding risks of poor oral hygiene should be provided to both staff and patients, especially those with dysphagia.

Ringworm on the Legs of a Patient after Long-term Intensive care Unit Residency

Ringworm on the Legs of a Patient after Long-term Intensive care Unit Residency

STOP-FALLING: A Simple Checklist Tool for Fall Prevention in a Nursing Facility

Falls are highly prevalent and lead to major health morbidity and mortality in older adults. We developed a “STOP-FALLING” checklist as a multifactorial intervention tool kit for a single long-term care facility. The objective of this study was to determine feasibility and adherence of the checklist, and to determine whether STOP-FALLING reduces total number of falls, frequent fallers, and fall-related injuries.This is a quality improvement demonstration project comparing the effect on falls 3 months before and 3 months after introducing a STOP-FALLING checklist. All older adult patients who lived in the long-term care unit of a single facility were included. PTs, geriatricians, and registered nurses participated in the STOP-FALLING initiative. Staff were surveyed on satisfaction by 8-item questionnaires, which were obtained 3 months after checklist implementation. Data on the rate of falls, the number of recurrent fallers, the number of minor injuries, and the number of major injuries 3 months prior and 3 months after the intervention were collected by facility fall log.A total of 32 patients were screened using the STOP-FALLING checklist. Staff survey revealed a high satisfaction rate with ≤15 minutes to complete the checklist. Data at 3 months after initiation of the checklist revealed a reduction in the fall rates (2.80-1.65 falls per person-year), number of frequent fallers (5.00-2.30/mo after), number of falls without injuries (3.00-1.67/mo), number of minor injuries (4.00-2.67/mo), and number of major injuries (0.33-0/mo).We observed excellent staff satisfaction using the STOP-FALLING checklist. Our pilot project suggests that the intervention may decrease fall rates and other fall-related injuries.

Cognitive Stimulation for Individuals with Parkinson's Disease Dementia Living in Long-Term Care: Preliminary Data from a Randomized Crossover Pilot Study.

Background While the efficacy of cognitive stimulation (CS) has been demonstrated in patients with dementia, no study has included patients with Parkinson's disease dementia (PDD). Objective For the first time, this randomized crossover pilot study examined the feasibility and potential effects of CS in PDD. Methods All residents of a PDD-specific long-term care unit in the Netherlands that were eligible for the study (n=12) were randomly allocated to group A (n=6) receiving CS (eight weeks, twice weekly for 60 minutes) or group B (n=6) receiving usual care (control group, CG). The CG participated in CS afterwards, resulting in an experimental group (EG), consisting of n=12. Pre- and postassessments and a six-week follow-up (FU) were conducted for cognition, neuropsychiatric symptoms, quality of life (QoL), and activities of daily living (ADL) outcomes. Results Between-group analysis with difference scores from pre- to posttest revealed a group difference for global cognition (CERAD total score) favoring the EG, with a moderate effect size and a p value just failing to reach statistical significance (p=0.067; r = 0.43). A further statistical trend was observed for neuropsychiatric symptoms, again with a moderate effect size (p=0.075; r = 0.42). Within-group analyses indicated improvement only in the EG with large effects also just failing to reach significance for global cognition (short term, p=0.060; r = 0.70) as well as for depression (long term, p=0.072; r = 0.61). ADL deteriorated significantly at FU in the EG (p=0.014; r = 0.71). Conclusions Although our data are preliminary due to the small sample size, this study shows that CS is feasible and potentially effective for cognitive and noncognitive outcomes in PDD patients. Randomized controlled trials with larger sample sizes are needed to confirm these promising results.