Effects of postoperative cognitive training on neurocognitive decline after heart surgery: a randomized clinical trial

Abstract

Objectives Following cardiac surgery, postoperative cognitive decline (POCD) is a common complication that can impair quality of life and increase mortality. The aim of this study was to investigate whether early postoperative cognitive training can decrease POCD after cardiac surgery. Methods The study was a multi-centered, 2-arm, randomized (1:1 ratio), controlled trial involving older patients undergoing elective heart valve surgery with extracorporeal circulation. Recruitment took place at the Departments of Cardiac Surgery of the Kerckhoff-Clinic in Bad Nauheim (Germany) and the University-Hospital in Giessen (Germany). The patients were randomized to either a paper-and-pencil-based cognitive training group or a standard rehabilitation care control group. The cognitive training started 1 week after surgery and lasted about 3 weeks until discharge from rehabilitation. To detect POCD, neuropsychological functions were assessed prior to surgery, upon discharge from rehabilitation (primary outcome), and 3 months after discharge (secondary outcome). Data were primarily analyzed in a per-protocol fashion. Results The frequency of POCD at discharge from rehabilitation (training group, n = 37; control group, n = 44) was 50% in the control group and 19% in the training group (χ2[1]=8.45, p = 0.004; OR = 4.29, 95% CI [1.56–11.80]). Three months after the cognitive training (training group, n = 33; control group, n = 34), POCD frequency was 29% in the control group and 6% in the training group (χ2[1]=6.21, p = 0.013; OR = 6.46, 95% CI [1.29–32.28]). Conclusions Since our cognitive training showed beneficial effects, it could be a promising method to prevent POCD.

The impact of postoperative cognitive training on health‐related quality of life and cognitive failures in daily living after heart valve surgery: A randomized clinical trial

“…First, a comparison with patients without the use of an ECC or a healthy control cohort does not seem possible, as we only examined patients who had been operated with ECC. Related to the results reported here and a previously published article concerning the objectively determined frequency of POCD (Butz et al, 2022), another limitation of our study emerges.…”

“…In addition, preoperative administration of dexamethasone ameliorates the inflammatory response provoked by surgery, which is related to a reduction in the incidence of POCD (Glumac et al., 2017). As we have recently demonstrated in a prospective, randomized controlled interventional study, early postoperative paper‐and‐pencil–based cognitive training can reduce the incidence of objectively measurable POCD (Butz et al., 2022). To further elucidate the clinical relevance of our cognitive training, this report evaluates the training‐induced effects on health‐related quality of life and cognitive failure in daily living after cardiac surgery.…”

“…Age, sex, education, body mass index, preexisting conditions, and the severity partition for left ventricular ejection fraction (Lang et al, 2015) were A detailed description of the development and concept of the cognitive training (Butz et al, 2019) and its beneficial effects on cognition (Butz et al, 2022) have been published in advance.…”

Increasing preoperative cognitive reserve to prevent postoperative delirium and postoperative cognitive decline in cardiac surgical patients (INCORE): Study protocol for a randomized clinical trial on cognitive training

“…The difference in our study concept compared with the above-mentioned studies is that we use paper-and-pencil-based instead of computer-based cognitive training, which is probably more feasible and effective for older patients. Furthermore, our program will take place in the preoperative phase, which will help to address differences between preoperative and [as we have conducted in the past; ( 39 )] postoperative training. As we saw in the postoperative setting, this cognitive training appears to be adequately feasible regardless of educational status.…”

“…We have validated a postoperative paper-and-pencil-based cognitive training program for older cardiac-surgery patients with the effect of reduced POCD at discharge from rehabilitation (after 3 weeks of training) and at a 3-month follow-up ( 39 ). In the INCORE study, we will use this training program for the preoperative setting.…”