Perioperative Cognitive Protection—Cognitive Exercise and Cognitive Reserve (The Neurobics Trial): A Single-blind Randomized Trial

Humeidan, Michelle; Otey, Andrew J.; Zuleta-Alarcon, Alix; Mavarez-Martinez, Ana; Stoicea, Nicoleta; Bergese, Sergio D.

doi:10.1016/j.clinthera.2015.10.013

Cited by 18 publications

(6 citation statements)

References 50 publications

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“…Current evidence related to patient selection, although sparse, suggests that individuals with decreased functional capacity at baseline may benefit most from prehabilitation 97 ; however, these and related characteristics were rarely captured or reported in included reviews. For intervention design, we identified evidence of beneficial effects of both exercise and nutritional prehabilitation; however, 98,99 In included reviews, adherence rates were generally moderate (~70%), but these were widely variable. Finally, the minimum and maximum durations of prehabilitation programmes were also variable, although, where reported, most reviews reported programmes of at least a duration of 5 weeks, which may exceed acceptable wait times for urgent diagnoses, such as cancer.…”

Section: Discussionmentioning

confidence: 99%

Prehabilitation in adult patients undergoing surgery: an umbrella review of systematic reviews

McIsaac

Gill

Boland

et al. 2022

British Journal of Anaesthesia

123

101

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Section: Discussionmentioning

confidence: 99%

Prehabilitation in adult patients undergoing surgery: an umbrella review of systematic reviews

McIsaac

Gill

Boland

et al. 2022

British Journal of Anaesthesia

123

101

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“…36 -40 Once a cognitive impairment is suspected or diagnosed, preoperative physical and cognitive exercises have also been used to decrease the risk of delirium. 40,41 Knowledge of postoperative outcomes is an integral part of discharge planning, including anticipating if patients will require discharge to a rehabilitation facility, discharge home with special services, or have more frequent follow-up in the clinic as patients with MCI may have a decreased ability to care for wounds, manage medications, and participate adequately with physical rehabilitation. 42…”

Section: Discussionmentioning

confidence: 99%

Postoperative Outcomes in Primary Total Knee Arthroplasty Patients With Preexisting Cognitive Impairment: A Systematic Review

Erfe

Boehme

Erfe

et al. 2018

Geriatr Orthop Surg Rehabil

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Introduction:To evaluate the body of evidence on the predictive value of preoperative cognitive impairment on in-hospital, short-term, and midterm postoperative outcomes for elderly patients undergoing total knee arthroplasty (TKA).Significance:With an aging population, an increasing percentage of the U.S. patient population will be living with cognitive impairment. There is currently no systematic review that assesses postoperative outcomes of patients with mild cognitive impairment (MCI) or preexisting diagnosis of dementia while undergoing elective primary TKA.Results:A database search between January 1, 1997, and November 1, 2017 in EMBASE, MEDLINE, and PubMed was conducted to identify articles that compared postoperative outcomes after TKA between patients aged 60 years with and without cognitive impairment. Cognitive impairment included preexisting diagnosis of dementia or MCI identified during preoperative assessment. Eligible articles were selected using dual reviewer and third-party arbitrator. The quality of the studies was evaluated using the Newcastle-Ottawa Scale. The strength of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. A total of 6163 abstracts were screened. Only 11 full text articles met inclusion criteria, including 1 case–control, 5 prospective cohort, and 5 retrospective cohort studies. Two studies were of poor quality. Overall, there is moderate strength of evidence for increased risk of postoperative delirium, increased length of stay, and discharge to health-care facility among patients with preoperative MCI or preexisting dementia. The body of evidence is weak for other outcomes of interest including mortality, functionality and complications while in-hospital and in the short- and midterm.Conclusion:This review highlights the need for additional good quality studies to provide more information about MCI and dementia as risk factors in primary TKA.

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“…Cognitive prehabilitation is also being studied as an approach for strengthening cognitive reserve in surgical patients 74 . So-called “brain training” efforts have been hypothesized to curtail the risk of postoperative delirium and cognitive impairment.…”

Section: Recent Prevention Strategiesmentioning

confidence: 99%

“…Time commitment and preoperative anxiety served as barriers to training adherence, and those randomly assigned to training were more likely to withdraw from the study. Although larger-scale trials are ongoing (ClinicalTrials.gov Identifier: NCT02230605 74 ), cognitive prehabilitation may not be feasible for many older patients prior to surgery.…”

Section: Recent Prevention Strategiesmentioning

confidence: 99%

Recent Advances in Preventing and Managing Postoperative Delirium

Vlisides

Avidan

2019

F1000Res

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Postoperative delirium is a common and harrowing complication in older surgical patients. Those with cognitive impairment or dementia are at especially high risk for developing postoperative delirium; ominously, it is hypothesized that delirium can accelerate cognitive decline and the onset of dementia, or worsen the severity of dementia. Awareness of delirium has grown in recent years as various medical societies have launched initiatives to prevent postoperative delirium and alleviate its impact. Unfortunately, delirium pathophysiology is not well understood and this likely contributes to the current state of low-quality evidence that informs perioperative guidelines. Along these lines, recent prevention trials involving ketamine and dexmedetomidine have demonstrated inconsistent findings. Non-pharmacologic multicomponent initiatives, such as the Hospital Elder Life Program, have consistently reduced delirium incidence and burden across various hospital settings. However, a substantial portion of delirium occurrences are still not prevented, and effective prevention and management strategies are needed to complement such multicomponent non-pharmacologic therapies. In this narrative review, we examine the current understanding of delirium neurobiology and summarize the present state of prevention and management efforts.

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Perioperative Cognitive Protection—Cognitive Exercise and Cognitive Reserve (The Neurobics Trial): A Single-blind Randomized Trial

Abstract: To our knowledge, the Neurobics Trial is the first randomized, controlled study to investigate the effectiveness of a significant preoperative cognitive exercise regimen for the prevention of delirium after noncardiac, nonneurological surgery in elderly patients.

Cited by 18 publications

References 50 publications

Prehabilitation in adult patients undergoing surgery: an umbrella review of systematic reviews

Prehabilitation in adult patients undergoing surgery: an umbrella review of systematic reviews

Postoperative Outcomes in Primary Total Knee Arthroplasty Patients With Preexisting Cognitive Impairment: A Systematic Review

Recent Advances in Preventing and Managing Postoperative Delirium

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