Computerised cognitive training to improve cognition including delirium following coronary artery bypass grafting surgery: protocol for a blinded randomised controlled trial

Abstract

IntroductionCoronary artery bypass grafting (CABG) surgery is known to improve vascular function and cardiac-related mortality rates; however, it is associated with high rates of postoperative cognitive decline and delirium. Previous attempts to prevent post-CABG cognitive decline using pharmacological and surgical approaches have been largely unsuccessful. Cognitive prehabilitation and rehabilitation are a viable yet untested option for CABG patients. We aim to investigate the effects of preoperative cognitive training on delirium incidence, and preoperative and postoperative cognitive training on cognitive decline at 4 months post-CABG.Methods and analysisThis study is a randomised, single-blinded, controlled trial investigating the use of computerised cognitive training (CCT) both pre-CABG and post-CABG (intervention group) compared with usual care (control group) in older adults undergoing CABG in Adelaide, South Australia. Those in the intervention group will complete 1–2 weeks of CCT preoperatively (45–60 min sessions, 3.5 sessions/week) and 12 weeks of CCT postoperatively (commencing 1 month following surgery, 45–60 min sessions, 3 sessions/week). All participants will undergo cognitive testing preoperatively, over their hospital stay including delirium, and postoperatively for up to 1 year. The primary delirium outcome variable will be delirium incidence (presence vs absence); the primary cognitive decline variable will be at 4 months (significant decline vs no significant decline/improvement from baseline). Logistic regression modelling will be used, with age and gender as covariates. Secondary outcomes include cognitive decline from baseline to discharge, and at 6 months and 1 year post-CABG.Ethics and disseminationEthics approval was obtained from the Central Adelaide Local Health Network Human Research Ethics Committee (South Australia, Australia) and the University of South Australia Human Ethics Committee, with original approval obtained on 13 December 2017. It is anticipated that approximately two to four publications and multiple conference presentations (national and international) will result from this research.Trial registration numberThis clinical trial is registered with the Australian New Zealand Clinical Trials Registry and relates to the pre-results stage. Registration number: ACTRN12618000799257.

Delirium em CTI: ansiedade e depressão como possíveis fatores de risco na população idosa

“…Isso pode ser explicado pelo tempo limitado (48 horas) no qual os pacientes foram avaliados para essa síndrome. Além disso, trata-se de uma unidade intensiva clínica que não abrange os pacientes pós cirurgia cardíaca, os quais a literatura aponta maiores índices de delirium (Damluji et al, 2019;Ghaeli et al, 2018;Greaves et al, 2020;Schubert et al, 2018). No entanto, o índice de delirium encontrado até o momento corrobora com os achados de pesquisa recente realizada com idosos cardiopatas na Espanha -7% dos pacientes desenvolveram a síndrome (Vives-Borrás et al, 2019).…”

“…A cirurgia de revascularização do miocárdio também está associada a altos índices de delirium, podendo atingir até 72% dos pacientes no período pós-operatório (Greaves et al, 2020).…”

The effects of computerised cognitive training on post-CABG delirium and cognitive change: A prospective randomised controlled trial

“…A detailed description of the study protocol, including the timing of all study measurements, has been published. 24 In brief, the study was a single-blinded, randomised controlled trial with longitudinal follow-up comparing pre-and post-operative CCT (intervention group) with usual care (control group). Persons scheduled to undergo CABG or CABG plus a concomitant surgery, with at least one-week lead-up time before surgery, who were aged ≥65 years, spoke English proficiently and lived within a 1-hour drive from the Adelaide (South Australia) central business district were approached.…”

“…Persons scheduled to undergo CABG or CABG plus a concomitant surgery, with at least one-week lead-up time before surgery, who were aged ≥65 years, spoke English proficiently and lived within a 1-hour drive from the Adelaide (South Australia) central business district were approached. As detailed in the published protocol paper, 24 the target sample size was n=120. However, re-cruitment was severely impacted due to COVID-19 restrictions beginning in 2020, with the cancellation of elective procedures within the South Australian hospital system, resulting in scheduled surgeries of metropolitan patients being completed in private hospitals (not covered by ethical approval).…”

Does Preoperative Cognitive Optimization Improve Postoperative Outcomes in the Elderly?

“…The authors pointed out that enrollment in the program over a short timeframe may worsen preoperative anxiety and apprehension [76]. Computer-based cognitive training provided both preoperatively and postoperatively is currently being studied in older patients undergoing coronary artery bypass grafting surgery [77], where the cognitive domains most affected by heart failure (e.g., psychomotor speed, attention, memory, and executive function) are under investigation. Further, a randomized pilot study combining preoperative cognitive training and physical exercise prehabilitation is underway in older surgical patients [78].…”