Donna M. Fick, PhD, GCNS-BC, Associate Professor of Nursing, School of Nursing, Pennsylvania State University, University Park, PA, USA.
Ann Kolanowski, PhD, RN, FAAN, Elouise Ross Eberly Professor of Nursing, School of Nursing, Pennsylvania State University, University Park, PA, USA.

Delirium superimposed on dementia (DSD) is common, is associated with poor clinical and economic outcomes, and occurs across all settings of care. In this article, we briefly review outcomes of DSD, propose the idea of cognitive reserve as a possible mechanism for interventions that prevent and manage DSD, and present the evidence for delirium interventions. We conclude with implications for practice and suggest web-based resources for supporting best practices in the care of persons with DSD.
Key words: delirium, dementia, prevention, interventions, cognitive reserve.

Mario Masellis, MSc, MD, FRCPC, Clinical Associate & Research Fellow, L.C. Campbell Cognitive Neurology Research Unit, Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON.
Sandra E. Black, MD, FRCPC, Brill Professor of Neurology, L.C. Campbell Cognitive Neurology Research Unit, Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON.

Cognitive impairment occurs along a continuum from mild subjective memory complaints occurring during the normal aging process to severe memory and other cognitive deficits due to dementia, the most common subtype being mixed Alzheimer’s disease and vascular dementia. Due to the significant growth of the older adult population, the incidence of dementia is on the rise and is posing significant challenges for health care systems worldwide. Primary care practitioners are on the front lines of this battle against dementia and will play an increasingly important role in the early identification of disease. Cognitive screening tests are helpful in detecting people in the early stages of dementia and facilitate further clinical and diagnostic evaluations. Primary care practitioners should aggressively treat known cardiovascular risk factors for dementia and institute early symptomatic therapy when appropriate.
Key words: dementia, cognitive screening test, cognitive reserve, neuroimaging, biomarkers.