Elsevier Logo


Cognitive Impairment, Adult


Cognitive Impairment (Adult Inpatient)

Clinical Description

  • Care of the hospitalized patient experiencing impairment related to cognitive skills that include attention, memory, orientation, judgment, reasoning, problem-solving and executive functioning with reasonable potential for improvement.

Key Information

  • Language and culture may affect results of standardized assessment tools. Choose tools appropriate for the patient to provide the most accurate cognitive assessment.
  • Hospitalization and illness stress cognitive abilities and exacerbate dysfunctional behaviors.
  • It is important to identify and address safety concerns related to cognitive dysfunction, such as medication adherence, decision-making capacity, safety with functional mobility tasks and wandering.

Clinical Goals

By transition of care

A. The patient will achieve the following goals:
  • Optimal Functional Independence

B. Patient, family or significant other will teach back or demonstrate education topics and points:
  • Education: Overview
  • Education: Self Management
  • Education: When to Seek Medical Attention

Correlate Health Status

  • Correlate health status to:

    • history, comorbidity
    • age, developmental level
    • sex, gender identity
    • baseline assessment data
    • physiologic status
    • response to medication and interventions
    • psychosocial status, social determinants of health
    • barriers to accessing care and services
    • health literacy
    • cultural and spiritual preferences
    • safety risks
    • family interaction
    • plan for transition of care

Cognitive Impairment


  • aggression
  • agitation
  • concentration poor
  • confusion
  • crying
  • difficulty learning or following instructions
  • disorientation
  • distractibility
  • fatigue
  • forgetfulness
  • impulsive behavior
  • inappropriate behavior
  • judgment impaired
  • labile mood
  • lack of awareness of present events
  • problem-solving ability altered
  • speech difficulty

Diagnostic Results

  • imaging study abnormalities

Problem Intervention

Optimize Cognitive Function

  • Assess cognitive function using a standardized tool to establish baseline and identify areas of deficit.
  • Establish rapport and trust; utilize unhurried and calm approach.
  • Utilize clear communication; address patient by name, speak slowly with simple directions and gestures; provide time for patient response, listen carefully and maintain eye contact.
  • Refrain from correcting or contradicting the patient’s perception for optimal interaction.
  • Promote a safe and calm environment (e.g., supervision, assistance); avoid sensory overload or deprivation.
  • Promote use of personal vision and auditory aids; provide orientation cues (e.g., calendar, clock, pictures).
  • Establish familiarity using a structured routine congruent with home schedule, when possible, to decrease risk of confusion and agitation (e.g., family presence, consistent caregiver, sleep and meal schedule, toileting schedule).
  • Encourage multimodal physical activity, exercise and complementary interventions, such as mindfulness, meditation, yoga and tai chi; consider combined exercise and cognitive activity.
  • Facilitate participation in activities, such as word games, discussion of current events and reminiscing to stimulate cognitive function and promote enjoyment.
  • Implement cognitive remediation or restorative techniques, such as training in direct attention, occupation, activity-based and functional communication strategies.

Associated Documentation

  • Environment Familiarity/Consistency
  • Reorientation Measures
  • Self-Care Promotion
  • Sensory Stimulation Regulation


CPG-Specific Education Topics


  • description

  • signs/symptoms

Self Management

  • activity

  • assistive/adaptive devices

  • cognitive support measures

  • home safety

  • prevent skin breakdown

  • provider follow-up

  • rehabilitation therapy

When to Seek Medical Attention

  • unresolved/worsening symptoms

General Education Topics

General Education

  • admission, transition of care

  • orientation to care setting, routine

  • advance care planning

  • diagnostic tests/procedures

  • diet modification

  • opioid medication management

  • oral health

  • medication management

  • pain assessment process

  • safe medication disposal

  • tobacco use, smoke exposure

  • treatment plan

Safety Education

  • call light use

  • equipment/home supplies

  • fall prevention

  • harm prevention

  • infection prevention

  • MDRO (multidrug-resistant organism) care

  • personal health information

  • resources for support


  • Brenes, G. A.; Sohl, S.; Wells, R. E.; Befus, D.; Campos, C. L.; Danhauer, S. C.. The effects of yoga on patients with mild cognitive impairment and dementia: A scoping review. American Journal of Geriatric Psychiatry. 2019;27(2), 188-197. doi:10.1016/j.jagp.2018.10.013 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Bruderer-Hofstetter, M.; Rausch-Osthoff, A. K.; Meichtry, A.; Münzer, T.; Niedermann, K. Effective multicomponent interventions in comparison to active control and no interventions on physical capacity, cognitive function and instrumental activities of daily living in elderly people with and without mild impaired cognition–a systematic review and network meta-analysis. Ageing Research Reviews. 2018;45, 1-14. doi:10.1016/j.arr.2018.04.002 [Metasynthesis,Meta-analysis,Systematic Review]
  • Cicerone, K. D.; Goldin, Y.; Ganci, K.; Rosenbaum, A.; Wethe, J. V.; Langenbahn, D. M.; Malec, J. F.; Bergquist, T. F.; Kingsley, K.; Nagele, D.; Trexler, L.; Fraas, M.; Bogdanova, Y.; Harley, J. P. Evidence-based cognitive rehabilitation: Systematic review of the literature from 2009 through 2014. Archives of Physical Medicine and Rehabilitation. 2019; doi:10.1016/j.apmr.2019.02.011 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Dauwan, M.; Begemann, M. J.; Slot, M. I.; Lee, E. H.; Scheltens, P.; Sommer, I. E. Physical exercise improves quality of life, depressive symptoms, and cognition across chronic brain disorders: a transdiagnostic systematic review and meta-analysis of randomized controlled trials. Journal of Neurology. 2019;, 1-25. doi:10.1007/s00415-019-09493-9 [Metasynthesis,Meta-analysis,Systematic Review]
  • Erickson, K. I.; Hillman, C.; Stillman, C. M.; Ballard, R. M.; Bloodgood, B.; Conroy, D. E.; Macko, R.; Marquez, D. X.; Petruzzello, S. J.; Powell, K. E. Physical Activity, Cognition, and Brain Outcomes: A Review of the 2018 Physical Activity Guidelines. Medicine and Science in Sports and Exercise. 2019;51(6), 1242-1251. doi:10.1249/MSS.0000000000001936 [Metasynthesis,Meta-analysis,Systematic Review]
  • Gulanick, M.; Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions and outcomes. St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Hwang, A. B.; Boes, S.; Nyffeler, T.; Schuepfer, G. Validity of screening instruments for the detection of dementia and mild cognitive impairment in hospital inpatients: A systematic review of diagnostic accuracy studies. PloS One. 2019;14(7) doi:10.1371/journal.pone.0219569 Source[Metasynthesis,Meta-analysis,Systematic Review]
  • Kim, O.; Pang, Y.; Kim, J. H. The effectiveness of virtual reality for people with mild cognitive impairment or dementia: a meta-analysis. BMC Psychiatry. 2019;19(1), 219. doi:10.1186/s12888-019-2180 [Metasynthesis,Meta-analysis,Systematic Review]
  • Law, L. L. F.; Barnett, F.; Yau, M. K.; Gray, M. A. Effects of combined cognitive and exercise interventions on cognition in older adults with and without cognitive impairment: A systematic review. Ageing Research Reviews. 2014;(15), 61-75. [Metasynthesis,Meta-analysis,Systematic Review]
  • Leong, R. L.; Cheng, G. H. L.; Chee, M. W.; Lo, J. C. The effects of sleep on prospective memory: A systematic review and meta-analysis. Sleep Medicine Reviews. 2019; doi:10.1186/s12888-019-2180-x [Metasynthesis,Meta-analysis,Systematic Review]
  • Li, H.; Li, J.; Li, N.; Li, B.; Wang, P.; Zhou, T. Cognitive intervention for persons with mild cognitive impairment: A meta-analysis. Aging Research Reviews. 2011;10, 285-296. [Metasynthesis,Meta-analysis,Systematic Review]
  • Liang, J. H.; Xu, Y.; Lin, L.; Jia, R. X.; Zhang, H. B.; Hang, L. Comparison of multiple interventions for older adults with Alzheimer disease or mild cognitive impairment: A PRISMA-compliant network meta-analysis. Medicine. 2018;97(20) doi:10.1097/MD.0000000000010744 Source[Metasynthesis,Meta-analysis,Systematic Review]
  • Loprinzi, P. D.; Blough, J.; Ryu, S.; Kang, M. Experimental effects of exercise on memory function among mild cognitive impairment: systematic review and meta-analysis. The Physician and Sports Medicine. 2019;47(1), 21-26. doi:10.1080/00913847.2018.1527647 [Metasynthesis,Meta-analysis,Systematic Review]
  • McDonnell, M. N.; Smith, A. E.; MacKintosh, S. F. Aerobic exercise to improve cognitive function in adults with neurological disorders: A systematic review. Archives of Physical Medicine and Rehabilitation. 2011;92(7), 1044-1052. doi:10.1016/j.apmr.2011.01.021 [Metasynthesis,Meta-analysis,Systematic Review]
  • Northey, J. M.; Cherbuin, N.; Pumpa, K. L.; Smee, D. J.; Rattray, B. Exercise interventions for cognitive function in adults older than 50: a systematic review with meta-analysis. British Journal of Sports Medicine. 2018;52(3), 154-160. doi:10.1136/bjsports-2016-096587 [Metasynthesis,Meta-analysis,Systematic Review]
  • O'Halloran, R.; Grohn, B.; Worrall, L. Environmental factors that influence communication for patients with a communication disability in acute hospital stroke units: A qualitative metasynthesis. Archives of Physical Medicine and Rehabilitation. 2012;93(1 Suppl), S77; S85. doi:10.1016/j.apmr.2011.06.039 [Metasynthesis,Meta-analysis,Systematic Review]
  • Pendleton, H. M.; Schultz-Krohn, W. (2018). Pedretti's occupational therapy: Practice skills for physical dysfunction. St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Petersen, R. C.; Lopez, O.; Armstrong, M. J.; Getchius, T. S.; Ganguli, M.; Gloss, D.; Gronseth, G. S.; Marson, D.; Pringsheim, T.; Day, G. S.; Sager, M.; Stevens, J.; Rae Grant, A. Practice guideline update summary: Mild cognitive impairment: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2018, Jan;90(3), 126-135. doi:10.1212/WNL.000000000000482 [Quality Measures,Clinical Practice Guidelines]
  • Reuben, D. B.; Herr, K. A.; Pacala, J. T.; Pollock, B. G.; Potter, J. F.; Semla, T. P. (2017). Geriatrics at your fingertips 2017. (pp.73-79). New York: American Geriatrics Society. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Russell-Williams, J.; Jaroudi, W.; Perich, T.; Hoscheidt, S.; El Haj, M.; Moustafa, A. A. Mindfulness and meditation: Treating cognitive impairment and reducing stress in dementia. Reviews in the Neurosciences. 2018;29(7), 791-804. doi:10.1515/revneuro-2017-0066 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Song, D.; Doris, S. F.; Li, P. W.; Lei, Y. The effectiveness of physical exercise on cognitive and psychological outcomes in individuals with mild cognitive impairment: A systematic review and meta-analysis. International Journal of Nursing Studies. 2018;79, 155-164. doi:10.1016/j.ijnurstu.2018.01.002 [Metasynthesis,Meta-analysis,Systematic Review]
  • Swearingen, P. L.; Wright, J. (2019). All-in-One Nursing Care Planning Resource-E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health. Philadelphia: Elsevier Health Sciences. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Vining Radomski, M.; Trombly Latham, C. A. (2014). Occupational therapy for physical dysfunction. Baltimore: Wolters Kluwer/Lippincott Williams & Wilkins. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Yang, H. L.; Chan, P. T.; Chang, P. C.; Chiu, H. L.; Hsiao, S. T. S.; chu, H.; Chou, K. R. Memory-focused interventions for people with cognitive disorders: A systematic review and meta-analysis of randomized controlled studies. International Journal of Nursing Studies. 2017;78, 44-51. doi:10.1016/j.ijnurstu.2017.08.005 [Metasynthesis,Meta-analysis,Systematic Review]
  • Zou, L.; Loprinz, P. D.; Yeung, A. S.; Zeng, N.; Huang, T. The beneficial effects of mind-body exercises for people with mild cognitive impairment: A systematic review with meta-analysis. Archives of Physical Medicine and Rehabilitation. 2019; doi:10.1016/j.apmr.2019.03.009 Source[Metasynthesis,Meta-analysis,Systematic Review]


Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.