{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T12:26:36Z","timestamp":1786969596344,"version":"build-2736575974"},"reference-count":50,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T00:00:00Z","timestamp":1786752000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100019559","name":"Carl von Ossietzky Universit\u00e4t Oldenburg","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100019559","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Geriatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Delirium is a frequent and serious neuropsychiatric syndrome in older adults. People living with dementia are at particularly high risk of developing delirium. In nursing homes, where dementia prevalence is high, delirium superimposed on dementia (DSD) represents a major clinical challenge and research gap. Aim of the study is to produce reliable data on prevalence and incidence of DSD in nursing homes as well as to investigate risk factors, clinical course, physical activity patterns, and care processes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective multicenter cohort study will be conducted between August 2025 and July 2028 in three regions in northwestern Germany. Approximately 300 residents with dementia from about 20 nursing homes will be enrolled. Participants without DSD at baseline will undergo weekly delirium screening over six months using the Informant Assessment of Geriatric Delirium (I-AGeD), administered by trained research staff. In cases of positive screening, delirium severity and motor subtype will be assessed using the Delirium Rating Scale-Revised-98 (DRS-R-98) and Delirium Motor Subtype Scale (DMSS). Nursing and medical care processes related to delirium will be documented upon first occurrence of potential DSD. Physical activity will be assessed at baseline and reassessed at the first occurrence of potential DSD or, in participants without delirium, at the end of the six-month observation period. Prevalence and incidence of delirium will be estimated with adjustment for clustering at the nursing home level. Risk factors will be analyzed using multiple mixed logistic regression models, and time-to-event analyses will be applied for incident delirium. Explorative prognostic analyses will examine associations with cognitive decline, functional status, mortality, and physical activity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Findings will inform development of context-sensitive prevention and management strategies to strengthen evidence-based delirium care in nursing homes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>Prospectively registered on 17.04.2026 in the Deutsches Register f\u00fcr Klinische Studien (DRKS), (DRKS00039239; Date of registration in DRKS: 2026-04-17).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12877-026-08038-w","type":"journal-article","created":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T00:23:23Z","timestamp":1786753403000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Delirium superimposed on dementia in nursing homes: prevalence, incidence, and prognosis \u2013 protocol of a prospective multicenter cohort study"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0108-4459","authenticated-orcid":false,"given":"Vincent","family":"Molitor","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5448-8822","authenticated-orcid":false,"given":"Johanna Christina","family":"Seiters","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5108-158X","authenticated-orcid":false,"given":"Burkhard","family":"Haastert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4240-4080","authenticated-orcid":false,"given":"Nina","family":"Willerscheidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6118-1705","authenticated-orcid":false,"given":"Imke","family":"Aits","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0972-4377","authenticated-orcid":false,"given":"Tim","family":"Stuckenschneider","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0182-5373","authenticated-orcid":false,"given":"Falk","family":"Hoffmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7572-2011","authenticated-orcid":false,"given":"Michael H","family":"Freitag","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6858-4282","authenticated-orcid":false,"given":"Tania","family":"Zieschang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4910-8413","authenticated-orcid":false,"given":"Rebecca","family":"Palm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,15]]},"reference":[{"key":"8038_CR1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425787","volume-title":"The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR)","author":"American Psychiatric Association","year":"2022","unstructured":"American Psychiatric Association. 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