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

Abstract

IntroductionPostoperative delirium (POD) and postoperative cognitive decline (POCD) can be observed after cardiosurgical interventions. Taken together, these postoperative neurocognitive disorders (PNCDs) contribute to increased morbidity and mortality. Preoperative risk factors of PNCD, such as decreased neuropsychometric performance or decreased cognitive daily activities, can be interpreted as reduced cognitive reserve. This study aims to build up cognitive reserves to protect against the development of PNCD through preoperative, home-based, cognitive training.MethodsThe planned research project is a monocentric, two-arm randomized controlled intervention study involving 100 patients undergoing elective cardiac surgery with extracorporeal circulation. Patients will be assigned to a training group or control group. The intervention involves a standardized, paper-and-pencil-based cognitive training that will be performed by the patients at home for ~40 min per day over a preoperative period of 2–3 weeks. The control group will receive neither cognitive training nor a placebo intervention. A detailed assessment of psychological functions will be performed ~2–3 weeks before the start of training, at the end of the training, during hospitalization, at discharge from the acute clinic, and 3 months after surgery. The primary objective of this study is to investigate the interventional effect of preoperative cognitive training on the incidence of POD during the stay in the acute clinic, the incidence of POCD at the time of discharge from the acute clinic, and 3 months after surgery. Secondary objectives are to determine the training effect on objective cognitive functions before the surgery and subjective cognitive functions, as well as health-related quality of life 3 months after surgery.DiscussionShould it become evident that the use of our cognitive training can both reduce the incidence of POCD and POD and improve health-related quality of life, this intervention may be integrated into a standardized prehabilitation program.

Predicting Postoperative Delirium in Older Patients: a multicenter retrospective cohort study

“…These deficits may progress into POD. In line with this explanation, timely preoperative cognitive interventions can mitigate the risk of POD and long-term cognitive dysfunction after cardiac surgeries 51,52 . Additionally, patients with pre-existing cognitive decline face increased risks of other postoperative complications 53 .…”

“…Nonbinary categorical features, including location, SMI, types of anesthesia, and surgery, were one-hot encoded because they had no natural ordinal relationship among their categories, and assigning numerical labels to them could introduce bias or incorrect assumptions in the model. Seventy features were used, divided into preoperative (51) and perioperative (19) categories. Preoperative features encompassed demographic (7), clinical (23), surgical categories (6), and neuropsychological assessments (15).…”

Communication Regarding the Myocardial Ischemia/Reperfusion and Cognitive Impairment: A Narrative Literature Review

“…It is important to emphasize that blood pressure control, glucose control, cerebral perfusion and cerebral oxygen saturation management, temperature management, use of some preoperative medications, preoperative cognitive training, avoidance of some anesthetics as well as CPB, etc. have the potential to prevent cognitive impairment after cardiac surgery [144,[163][164][165][166][167][168] However, the subject of our review is the relationship between MI/RI and cognitive dysfunction after cardiac surgery, thus highlighting the neuroprotection of ischemic preconditioning in MI/RI. However, we are in no way dismissing the role of other strategies in MI/RI-related cognitive deficits; moreover, the evidence for other strategies has been detailed in previous reviews [146,169].…”