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Current Anesthesiology Reports
Published in: Current Anesthesiology Reports 1/2022

01-03-2022 | PREHABILITATION (B RIEDEL and S JACK, SECTION EDITORS)

Postoperative Delirium Prevention and Novel Cognitive Therapy Interventions

Authors: Kimberly F. Rengel, Christina S. Boncyk, Christopher G. Hughes

Published in: Current Anesthesiology Reports | Issue 1/2022

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Abstract

Purpose of Review

This review briefly describes our current understanding of postoperative delirium and examines prevention strategies studied over the past 10 years. It also explores the role of computerized cognitive training and its potential use in the perioperative setting to prevent postoperative delirium.

Recent Findings

Computerized cognitive training is based on neuroplasticity theory and holds promise for improving cognitive function across a wide range of patient populations. Applying this technology in the perioperative setting is feasible in small cohorts, and prehabilitation with cognitive therapy before major surgery shows benefit in reducing postoperative delirium.

Summary

Postoperative delirium is a prevalent and serious complication associated with major surgery. Current prevention strategies vary in efficacy. Prehabilitation with computerized cognitive training is a novel therapy that may increase cognitive reserve and protect vulnerable patients from developing perioperative neurocognitive disorders.
Literature
1.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, 2013.
2.
Lipowski ZJ. Transient cognitive disorders (delirium, acute confusional states) in the elderly. Am J Psychiatry. 1983;140(11):1426–36.PubMedCrossRef
3.
Vasilevskis EE, Han JH, Hughes CG, Ely EW. Epidemiology and risk factors for delirium across hospital settings. Best Pract Res Clin Anaesthesiol. 2012;26(3):277–87.PubMedPubMedCentralCrossRef
4.
Brown CH, Laflam A, Max L, Lymar D, Neufeld KJ, Tian J, et al. The Impact of Delirium After Cardiac Surgical Procedures on Postoperative Resource Use. Ann Thorac Surg. 2016;101(5):1663–9.PubMedPubMedCentralCrossRef
5.
Brown CH, LaFlam A, Max L, Wyrobek J, Neufeld KJ, Kebaish KM, et al. Delirium After Spine Surgery in Older Adults: Incidence, Risk Factors, and Outcomes. J Am Geriatr Soc. 2016;64(10):2101–8.PubMedPubMedCentralCrossRef
6.
Moskowitz EE, Overbey DM, Jones TS, Jones EL, Arcomano TR, Moore JT, et al. Post-operative delirium is associated with increased 5-year mortality. Am J Surg. 2017;214(6):1036–8.PubMedCrossRef
7.
Witlox J, Eurelings LS, de Jonghe JF, Kalisvaart KJ, Eikelenboom P, van Gool WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA. 2010;304(4):443–51.PubMedCrossRef
8.
Hughes CG, Patel MB, Jackson JC, Girard TD, Geevarghese SK, Norman BC, et al. Surgery and Anesthesia Exposure Is Not a Risk Factor for Cognitive Impairment After Major Noncardiac Surgery and Critical Illness. Ann Surg. 2017;265(6):1126–33.PubMedCrossRef
9.
Inouye SK, Marcantonio ER, Kosar CM, Tommet D, Schmitt EM, Travison TG, et al. The short-term and long-term relationship between delirium and cognitive trajectory in older surgical patients. Alzheimer's Dement. 2016;12(7):766–75.CrossRef
10.
Lingehall HC, Smulter NS, Lindahl E, Lindkvist M, Engstrom KG, Gustafson YG, et al. Preoperative Cognitive Performance and Postoperative Delirium Are Independently Associated With Future Dementia in Older People Who Have Undergone Cardiac Surgery: A Longitudinal Cohort Study. Crit Care Med. 2017;45(8):1295–303.PubMedPubMedCentralCrossRef
11.
Sprung J, Roberts RO, Weingarten TN, Nunes Cavalcante A, Knopman DS, Petersen RC, et al. Postoperative delirium in elderly patients is associated with subsequent cognitive impairment. Br J Anaesth. 2017;119(2):316–23.PubMedCrossRef
12.
Evered L, Silbert B, Knopman DS, Scott DA, DeKosky ST, Rasmussen LS, et al. Recommendations for the Nomenclature of Cognitive Change Associated with Anaesthesia and Surgery-2018. Anesthesiology. 2018;129(5):872–9.PubMedCrossRef
13.
• Hshieh TT, Saczynski J, Gou RY, Marcantonio E, Jones RN, Schmitt E, et al. Trajectory of Functional Recovery After Postoperative Delirium in Elective Surgery. Ann Surg. 2017;265(4):647–53. This large prospective observational trial demonstrated the long-lasting impact of postoperative delirium on recovery in older adults. Investigators assessed older adults who underwent major elective surgery for delirium daily in the hospital and then assessed for functional recovery at multiple time points up to 18 months postoperatively. Participants who developed delirium demonstrated less physical functional recovery than those who did not develop delirium for up to 18 months after surgery.PubMedCrossRef
14.
Quinlan N, Rudolph JL. Postoperative delirium and functional decline after noncardiac surgery. J Am Geriatr Soc. 2011;59(Suppl 2):S301–4.PubMedCrossRef
15.
Fried TR, Bradley EH, Towle VR, Allore H. Understanding the treatment preferences of seriously ill patients. N Engl J Med. 2002;346(14):1061–6.PubMedCrossRef
16.
17.
Flacker JM, Cummings V, Mach JR Jr, Bettin K, Kiely DK, Wei J. The association of serum anticholinergic activity with delirium in elderly medical patients. Am J Geriatr Psychiatry. 1998;6(1):31–41.PubMedCrossRef
18.
Maldonado JR. Delirium pathophysiology: An updated hypothesis of the etiology of acute brain failure. Int J Geriatr Psychiatry. 2018;33(11):1428–57.PubMedCrossRef
19.
Plaschke K, Thomas C, Engelhardt R, Teschendorf P, Hestermann U, Weigand MA, et al. Significant correlation between plasma and CSF anticholinergic activity in presurgical patients. Neurosci Lett. 2007;417(1):16–20.PubMedCrossRef
20.
Liu P, Li YW, Wang XS, Zou X, Zhang DZ, Wang DX, et al. High serum interleukin-6 level is associated with increased risk of delirium in elderly patients after noncardiac surgery: a prospective cohort study. Chin Med J (Engl). 2013;126(19):3621–7.PubMed
21.
Vasunilashorn SM, Ngo L, Inouye SK, Libermann TA, Jones RN, Alsop DC, et al. Cytokines and Postoperative Delirium in Older Patients Undergoing Major Elective Surgery. J Gerontol A Biol Sci Med Sci. 2015;70(10):1289–95.PubMedPubMedCentralCrossRef
22.
Vasunilashorn SM, Ngo LH, Chan NY, Zhou W, Dillon ST, Otu HH, et al. Development of a Dynamic Multi-Protein Signature of Postoperative Delirium. J Gerontol A Biol Sci Med Sci. 2019;74(2):261–8.PubMedCrossRef
23.
Hov KR, Berg JP, Frihagen F, Raeder J, Hall R, Wyller TB, et al. Blood-Cerebrospinal Fluid Barrier Integrity in Delirium Determined by Q-Albumin. Dement Geriatr Cogn Disord. 2016;41(3-4):192–8.PubMedCrossRef
24.
Hughes CG, Pandharipande PP, Thompson JL, Chandrasekhar R, Ware LB, Ely EW, et al. Endothelial Activation and Blood-Brain Barrier Injury as Risk Factors for Delirium in Critically Ill Patients. Crit Care Med. 2016;44(9):e809–17.PubMedPubMedCentralCrossRef
25.
Reinsfelt B, Ricksten SE, Zetterberg H, Blennow K, Freden-Lindqvist J, Westerlind A. Cerebrospinal fluid markers of brain injury, inflammation, and blood-brain barrier dysfunction in cardiac surgery. Ann Thorac Surg. 2012;94(2):549–55.PubMedCrossRef
26.
Ansaloni L, Catena F, Chattat R, Fortuna D, Franceschi C, Mascitti P, et al. Risk factors and incidence of postoperative delirium in elderly patients after elective and emergency surgery. Br J Surg. 2010;97(2):273–80.PubMedCrossRef
27.
Berger M, Nadler JW, Browndyke J, Terrando N, Ponnusamy V, Cohen HJ, et al. Postoperative Cognitive Dysfunction: Minding the Gaps in Our Knowledge of a Common Postoperative Complication in the Elderly. Anesthesiol Clin. 2015;33(3):517–50.PubMedPubMedCentralCrossRef
28.
van der Sluis FJ, Buisman PL, Meerdink M, Aan de Stegge WB, van Etten B, de Bock GH, et al. Risk factors for postoperative delirium after colorectal operation. Surgery. 2017;161(3):704–11.PubMedCrossRef
29.
Jung P, Pereira MA, Hiebert B, Song X, Rockwood K, Tangri N, et al. The impact of frailty on postoperative delirium in cardiac surgery patients. J Thorac Cardiovasc Surg. 2015;149(3):869–75 e1-2.PubMedCrossRef
30.
Mahanna-Gabrielli E, Zhang K, Sieber FE, Lin HM, Liu X, Sewell M, et al. Frailty Is Associated With Postoperative Delirium But Not With Postoperative Cognitive Decline in Older Noncardiac Surgery Patients. Anesth Analg. 2020;130(6):1516–23.PubMedPubMedCentralCrossRef
31.
•• Culley DJ, Flaherty D, Fahey MC, Rudolph JL, Javedan H, Huang CC, et al. Poor Performance on a Preoperative Cognitive Screening Test Predicts Postoperative Complications in Older Orthopedic Surgical Patients. Anesthesiology. 2017;127(5):765–74. This study highlights the importance of testing for cognitive function preoperatively. Investigators demonstrated that a striking 25% of older adults without a previous diagnosis of dementia who were scheduled for elective orthopedic surgery screened positive for probable cognitive impairment. Furthermore, those with probable cognitive impairment were more likely to develop postoperative delirium and have a longer length of hospital stay.PubMedCrossRef
32.
Tiwary N, Treggiari MM, Yanez ND, Kirsch JR, Tekkali P, Taylor CC, et al. Agreement Between the Mini-Cog in the Preoperative Clinic and on the Day of Surgery and Association With Postanesthesia Care Unit Delirium: A Cohort Study of Cognitive Screening in Older Adults. Anesth Analg. 2020;
33.
Jones RN, Fong TG, Metzger E, Tulebaev S, Yang FM, Alsop DC, et al. Aging, brain disease, and reserve: implications for delirium. Am J Geriatr Psychiatry. 2010;18(2):117–27.PubMedPubMedCentralCrossRef
34.
Quinlan N, Marcantonio ER, Inouye SK, Gill TM, Kamholz B, Rudolph JL. Vulnerability: the crossroads of frailty and delirium. J Am Geriatr Soc. 2011;59(Suppl 2):S262–8.PubMedPubMedCentralCrossRef
35.
• Susano MJ, Grasfield RH, Friese M, Rosner B, Crosby G, Bader AM, et al. Brief Preoperative Screening for Frailty and Cognitive Impairment Predicts Delirium after Spine Surgery. Anesthesiology. 2020;133(6):1184–91. This prospective cohort study helped define the population at risk for developing postoperative delirium using simple screening tools for frailty and cognitive impairment. In 229 older adults awaiting major spine surgery, the presence of frailty or cognitive impairment at preoperative evaluation was both associated with developing postoperative delirium. Thus, identifying these patients preoperatively will allow better allocation of resources and interventions to prevent postoperative delirium.PubMedCrossRef
36.
Sweeney MD, Kisler K, Montagne A, Toga AW, Zlokovic BV. The role of brain vasculature in neurodegenerative disorders. Nat Neurosci. 2018;21(10):1318–31.PubMedPubMedCentralCrossRef
37.
Yang AC, Stevens MY, Chen MB, Lee DP, Stahli D, Gate D, et al. Physiological blood-brain transport is impaired with age by a shift in transcytosis. Nature. 2020;583(7816):425–30.PubMedPubMedCentralCrossRef
38.
Coleman PD, Flood DG. Neuron numbers and dendritic extent in normal aging and Alzheimer's disease. Neurobiol Aging. 1987;8(6):521–45.PubMedCrossRef
39.
Tijms BM, Wink AM, de Haan W, van der Flier WM, Stam CJ, Scheltens P, et al. Alzheimer's disease: connecting findings from graph theoretical studies of brain networks. Neurobiol Aging. 2013;34(8):2023–36.PubMedCrossRef
40.
Cavallari M, Dai W, Guttmann CR, Meier DS, Ngo LH, Hshieh TT, et al. Neural substrates of vulnerability to postsurgical delirium as revealed by presurgical diffusion MRI. Brain. 2016;139(Pt 4):1282–94.PubMedPubMedCentralCrossRef
41.
•• van Montfort SJT, van Dellen E, Stam CJ, Ahmad AH, Mentink LJ, Kraan CW, et al. Brain network disintegration as a final common pathway for delirium: a systematic review and qualitative meta-analysis. Neuroimage Clin. 2019;23:101809. Risk factors for delirium are highly variable, and the underlying mechanism contributing to delirium development remains poorly understood. This qualitative meta-analysis supports an emerging theory of the critical role brain network organization may have in developing delirium. The meta-analysis included 126 brain network studies of delirium and its risk factors and found that both were associated with functional network disruptions.
42.
Djaiani G, Silverton N, Fedorko L, Carroll J, Styra R, Rao V, et al. Dexmedetomidine versus Propofol Sedation Reduces Delirium after Cardiac Surgery: A Randomized Controlled Trial. Anesthesiology. 2016;124(2):362–8.PubMedCrossRef
43.
Pandharipande PP, Pun BT, Herr DL, Maze M, Girard TD, Miller RR, et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA. 2007;298(22):2644–53.PubMedCrossRef
44.
Riker RR, Shehabi Y, Bokesch PM, Ceraso D, Wisemandle W, Koura F, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA. 2009;301(5):489–99.PubMedCrossRef
45.
Shehabi Y, Grant P, Wolfenden H, Hammond N, Bass F, Campbell M, et al. Prevalence of delirium with dexmedetomidine compared with morphine based therapy after cardiac surgery: a randomized controlled trial (DEXmedetomidine COmpared to Morphine-DEXCOM Study). Anesthesiology. 2009;111(5):1075–84.PubMedCrossRef
46.
Liu Y, Ma L, Gao M, Guo W, Ma Y. Dexmedetomidine reduces postoperative delirium after joint replacement in elderly patients with mild cognitive impairment. Aging Clin Exp Res. 2016;28(4):729–36.PubMedCrossRef
47.
• Deiner S, Luo X, Lin HM, Sessler DI, Saager L, Sieber FE, et al. Intraoperative Infusion of Dexmedetomidine for Prevention of Postoperative Delirium and Cognitive Dysfunction in Elderly Patients Undergoing Major Elective Noncardiac Surgery: A Randomized Clinical Trial. JAMA Surg. 2017;152(8):e171505. This important study investigated the effectiveness of dexmedetomidine to reduce postoperative delirium in older adults. In this multicenter, double-blind, randomized, placebo-controlled trial, older adults undergoing major elective noncardiac surgery received an infusion of dexmedetomidine intraoperatively and postoperatively for two hours in the recovery room. Patients were then assessed daily for in-hospital delirium postoperatively. There was no difference between the treatment and placebo groups in developing postoperative delirium.PubMedPubMedCentralCrossRef
48.
Li X, Yang J, Nie XL, Zhang Y, Li XY, Li LH, et al. Impact of dexmedetomidine on the incidence of delirium in elderly patients after cardiac surgery: A randomized controlled trial. PLoS One. 2017;12(2):e0170757.PubMedPubMedCentralCrossRef
49.
• Turan A, Duncan A, Leung S, Karimi N, Fang J, Mao G, et al. Dexmedetomidine for reduction of atrial fibrillation and delirium after cardiac surgery (DECADE): a randomised placebo-controlled trial. Lancet. 2020;396(10245):177–85. Dexmedetomidine has previously been demonstrated to reduce delirium after cardiac surgery. This large randomized controlled trial studied the effect of dexmedetomidine infusion intraoperatively and for 24 hours postoperatively on rates of atrial fibrillation and postoperative delirium when compared to a placebo. Investigators found no difference in either outcome when given dexmedetomidine.PubMedCrossRef
50.
51.
Katznelson R, Djaiani GN, Borger MA, Friedman Z, Abbey SE, Fedorko L, et al. Preoperative use of statins is associated with reduced early delirium rates after cardiac surgery. Anesthesiology. 2009;110(1):67–73.PubMedCrossRef
52.
Mariscalco G, Cottini M, Zanobini M, Salis S, Dominici C, Banach M, et al. Preoperative statin therapy is not associated with a decrease in the incidence of delirium after cardiac operations. Ann Thorac Surg. 2012;93(5):1439–47.PubMedCrossRef
53.
Billings FT, Hendricks PA, Schildcrout JS, Shi Y, Petracek MR, Byrne JG, et al. High-Dose Perioperative Atorvastatin and Acute Kidney Injury Following Cardiac Surgery: A Randomized Clinical Trial. JAMA. 2016;315(9):877–88.PubMedPubMedCentralCrossRef
54.
Royse CF, Saager L, Whitlock R, Ou-Young J, Royse A, Vincent J, et al. Impact of Methylprednisolone on Postoperative Quality of Recovery and Delirium in the Steroids in Cardiac Surgery Trial: A Randomized, Double-blind. Placebo-controlled Substudy. Anesthesiology. 2017;126(2):223–33.PubMedCrossRef
55.
Whitlock RP, Devereaux PJ, Teoh KH, Lamy A, Vincent J, Pogue J, et al. Methylprednisolone in patients undergoing cardiopulmonary bypass (SIRS): a randomised, double-blind, placebo-controlled trial. Lancet. 2015;386(10000):1243–53.PubMedCrossRef
56.
• Avidan MS, Maybrier HR, Abdallah AB, Jacobsohn E, Vlisides PE, Pryor KO, et al. Intraoperative ketamine for prevention of postoperative delirium or pain after major surgery in older adults: an international, multicentre, double-blind, randomised clinical trial. Lancet. 2017;390(10091):267–75. This is the largest randomized controlled trial evaluating the effectiveness of adding a single dose of subanesthetic ketamine to the general anesthetic regimen to reduce the incidence of postoperative delirium. Participants were randomized to high dose ketamine, low dose ketamine, or placebo and assessed postoperatively for delirium. No difference in delirium was found between the groups; the ketamine groups did report more nightmares and hallucinations.PubMedPubMedCentralCrossRef
57.
Hollinger A, Rust CA, Riegger H, Gysi B, Tran F, Brugger J, et al. Ketamine vs. haloperidol for prevention of cognitive dysfunction and postoperative delirium: A phase IV multicentre randomised placebo-controlled double-blind clinical trial. J Clin Anesth. 2021;68:110099.PubMedCrossRef
58.
Fukata S, Kawabata Y, Fujishiro K, Kitagawa Y, Kuroiwa K, Akiyama H, et al. Haloperidol prophylaxis for preventing aggravation of postoperative delirium in elderly patients: a randomized, open-label prospective trial. Surg Today. 2017;47(7):815–26.PubMedCrossRef
59.
Fukata S, Kawabata Y, Fujisiro K, Katagawa Y, Kuroiwa K, Akiyama H, et al. Haloperidol prophylaxis does not prevent postoperative delirium in elderly patients: a randomized, open-label prospective trial. Surg Today. 2014;44(12):2305–13.PubMedCrossRef
60.
Larsen KA, Kelly SE, Stern TA, Bode RH Jr, Price LL, Hunter DJ, et al. Administration of olanzapine to prevent postoperative delirium in elderly joint-replacement patients: a randomized, controlled trial. Psychosomatics. 2010;51(5):409–18.PubMedCrossRef
61.
van den Boogaard M, Slooter AJC, Bruggemann RJM, Schoonhoven L, Beishuizen A, Vermeijden JW, et al. Effect of Haloperidol on Survival Among Critically Ill Adults With a High Risk of Delirium: The REDUCE Randomized Clinical Trial. JAMA. 2018;319(7):680–90.PubMedPubMedCentralCrossRef
62.
Leung JM, Sands LP, Chen N, Ames C, Berven S, Bozic K, et al. Perioperative Gabapentin Does Not Reduce Postoperative Delirium in Older Surgical Patients: A Randomized Clinical Trial. Anesthesiology. 2017;127(4):633–44.PubMedCrossRef
63.
Subramaniam B, Shankar P, Shaefi S, Mueller A, O'Gara B, Banner-Goodspeed V, et al. Effect of Intravenous Acetaminophen vs Placebo Combined With Propofol or Dexmedetomidine on Postoperative Delirium Among Older Patients Following Cardiac Surgery: The DEXACET Randomized Clinical Trial. JAMA. 2019;321(7):686–96.PubMedPubMedCentralCrossRef
64.
Besch G, Vettoretti L, Claveau M, Boichut N, Mahr N, Bouhake Y, et al. Early post-operative cognitive dysfunction after closed-loop versus manual target controlled-infusion of propofol and remifentanil in patients undergoing elective major non-cardiac surgery: Protocol of the randomized controlled single-blind POCD-ELA trial. Medicine (Baltimore). 2018;97(40):e12558.PubMedPubMedCentralCrossRef
65.
Tang CJ, Jin Z, Sands LP, Pleasants D, Tabatabai S, Hong Y, et al. ADAPT-2: A Randomized Clinical Trial to Reduce Intraoperative EEG Suppression in Older Surgical Patients Undergoing Major Noncardiac Surgery. Anesth Analg. 2020;131(4):1228–36.PubMedPubMedCentralCrossRef
66.
• Wildes TS, Mickle AM, Ben Abdallah A, Maybrier HR, Oberhaus J, Budelier TP, et al. Effect of Electroencephalography-Guided Anesthetic Administration on Postoperative Delirium Among Older Adults Undergoing Major Surgery: The ENGAGES Randomized Clinical Trial. JAMA. 2019;321(5):473–83. This large, randomized trial sought to address the utility of EEG-guided anesthesia to reduce postoperative delirium in older adults after major surgery. The EEG-guided group achieved significantly lower median end-tidal volatile anesthetic levels and experienced less EEG-suppression intraoperatively. However, this did not translate into a difference in postoperative delirium.PubMedPubMedCentralCrossRef
67.
Evered LA, Chan MTV, Han R, Chu MHM, Cheng BP, Scott DA, et al. Anaesthetic depth and delirium after major surgery: a randomised clinical trial. Br J Anaesth. 2021;127(5):704–12.PubMedCrossRef
68.
Fritz BA, Kalarickal PL, Maybrier HR, Muench MR, Dearth D, Chen Y, et al. Intraoperative Electroencephalogram Suppression Predicts Postoperative Delirium. Anesth Analg. 2016;122(1):234–42.PubMedPubMedCentralCrossRef
69.
Fritz BA, Maybrier HR, Avidan MS. Intraoperative electroencephalogram suppression at lower volatile anaesthetic concentrations predicts postoperative delirium occurring in the intensive care unit. Br J Anaesth. 2018;121(1):241–8.PubMedPubMedCentralCrossRef
70.
Whitlock EL, Torres BA, Lin N, Helsten DL, Nadelson MR, Mashour GA, et al. Postoperative delirium in a substudy of cardiothoracic surgical patients in the BAG-RECALL clinical trial. Anesth Analg. 2014;118(4):809–17.PubMedPubMedCentralCrossRef
71.
Hughes CG, Boncyk CS, Culley DJ, Fleisher LA, Leung JM, McDonagh DL, et al. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Delirium Prevention. Anesth Analg. 2020;130(6):1572–90.PubMedPubMedCentralCrossRef
72.
Whitlock EL, Braehler MR, Kaplan JA, Finlayson E, Rogers SE, Douglas V, et al. Derivation, Validation, Sustained Performance, and Clinical Impact of an Electronic Medical Record-Based Perioperative Delirium Risk Stratification Tool. Anesth Analg. 2020;131(6):1901–10.PubMedPubMedCentralCrossRef
73.
Donovan AL, Braehler MR, Robinowitz DL, Lazar AA, Finlayson E, Rogers S, et al. An Implementation-Effectiveness Study of a Perioperative Delirium Prevention Initiative for Older Adults. Anesth Analg. 2020;131(6):1911–22.PubMedPubMedCentralCrossRef
74.
Inouye SK, Bogardus ST Jr, Charpentier PA, Leo-Summers L, Acampora D, Holford TR, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999;340(9):669–76.PubMedCrossRef
75.
Marcantonio ER, Flacker JM, Wright RJ, Resnick NM. Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc. 2001;49(5):516–22.PubMedCrossRef
76.
Pun BT, Balas MC, Barnes-Daly MA, Thompson JL, Aldrich JM, Barr J, et al. Caring for Critically Ill Patients with the ABCDEF Bundle: Results of the ICU Liberation Collaborative in Over 15,000 Adults. Crit Care Med. 2019;47(1):3–14.PubMedPubMedCentralCrossRef
77.
Reston JT, Schoelles KM. In-facility delirium prevention programs as a patient safety strategy: a systematic review. Ann Intern Med. 2013;158(5 Pt 2):375–80.PubMedCrossRef
78.
Siddiqi N, Harrison JK, Clegg A, Teale EA, Young J, Taylor J, et al. Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev. 2016;3:CD005563.PubMed
79.
80.
Gillis C, Li C, Lee L, Awasthi R, Augustin B, Gamsa A, et al. Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology. 2014;121(5):937–47.PubMedCrossRef
81.
Topp R, Swank AM, Quesada PM, Nyland J, Malkani A. The effect of prehabilitation exercise on strength and functioning after total knee arthroplasty. PM R. 2009;1(8):729–35.PubMedCrossRef
82.
Nielsen PR, Jorgensen LD, Dahl B, Pedersen T, Tonnesen H. Prehabilitation and early rehabilitation after spinal surgery: randomized clinical trial. Clin Rehabil. 2010;24(2):137–48.PubMedCrossRef
83.
Bruns ER, van den Heuvel B, Buskens CJ, van Duijvendijk P, Festen S, Wassenaar EB, et al. The effects of physical prehabilitation in elderly patients undergoing colorectal surgery: a systematic review. Colorectal Dis. 2016;18(8):O267–77.PubMedCrossRef
84.
Moran J, Guinan E, McCormick P, Larkin J, Mockler D, Hussey J, et al. The ability of prehabilitation to influence postoperative outcome after intra-abdominal operation: A systematic review and meta-analysis. Surgery. 2016;160(5):1189–201.PubMedCrossRef
85.
Barberan-Garcia A, Ubre M, Roca J, Lacy AM, Burgos F, Risco R, et al. Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery: A Randomized Blinded Controlled Trial. Ann Surg. 2018;267(1):50–6.PubMedCrossRef
86.
Thomas G, Tahir MR, Bongers BC, Kallen VL, Slooter GD, van Meeteren NL. Prehabilitation before major intra-abdominal cancer surgery: A systematic review of randomised controlled trials. Eur J Anaesthesiol. 2019;36(12):933–45.PubMedPubMedCentralCrossRef
87.
Grindem H, Granan LP, Risberg MA, Engebretsen L, Snyder-Mackler L, Eitzen I. How does a combined preoperative and postoperative rehabilitation programme influence the outcome of ACL reconstruction 2 years after surgery? A comparison between patients in the Delaware-Oslo ACL Cohort and the Norwegian National Knee Ligament Registry. Br J Sports Med. 2015;49(6):385–9.PubMedCrossRef
88.
Green DJ, Walsh JH, Maiorana A, Best MJ, Taylor RR, O'Driscoll JG. Exercise-induced improvement in endothelial dysfunction is not mediated by changes in CV risk factors: pooled analysis of diverse patient populations. Am J Phys Heart Circ Physiol. 2003;285(6):H2679–H87.CrossRef
89.
Hambrecht R, Fiehn E, Weigl C, Gielen S, Hamann C, Kaiser R, et al. Regular physical exercise corrects endothelial dysfunction and improves exercise capacity in patients with chronic heart failure. Circulation. 1998;98(24):2709–15.PubMedCrossRef
90.
Toborek M, Seelbach MJ, Rashid CS, Andras IE, Chen L, Park M, et al. Voluntary exercise protects against methamphetamine-induced oxidative stress in brain microvasculature and disruption of the blood-brain barrier. Mol Neurodegener. 2013;8:22.PubMedPubMedCentralCrossRef
91.
Wolff G, Davidson SJ, Wrobel JK, Toborek M. Exercise maintains blood-brain barrier integrity during early stages of brain metastasis formation. Biochem Biophys Res Commun. 2015;463(4):811–7.PubMedPubMedCentralCrossRef
92.
Reiter K, Nielson KA, Smith TJ, Weiss LR, Alfini AJ, Smith JC. Improved Cardiorespiratory Fitness Is Associated with Increased Cortical Thickness in Mild Cognitive Impairment. J Int Neuropsychol Soc. 2015;21(10):757–67.PubMedPubMedCentralCrossRef
93.
94.
Chirles TJ, Reiter K, Weiss LR, Alfini AJ, Nielson KA, Smith JC. Exercise Training and Functional Connectivity Changes in Mild Cognitive Impairment and Healthy Elders. J Alzheimers Dis. 2017;57(3):845–56.PubMedPubMedCentralCrossRef
95.
Robinson TN, Wu DS, Pointer LF, Dunn CL, Moss M. Preoperative cognitive dysfunction is related to adverse postoperative outcomes in the elderly. J Am Coll Surg. 2012;215(1):12–7. discussion 7-8PubMedPubMedCentralCrossRef
96.
Tow A, Holtzer R, Wang C, Sharan A, Kim SJ, Gladstein A, et al. Cognitive Reserve and Postoperative Delirium in Older Adults. J Am Geriatr Soc. 2016;64(6):1341–6.PubMedPubMedCentralCrossRef
97.
Ball K, Berch DB, Helmers KF, Jobe JB, Leveck MD, Marsiske M, et al. Effects of cognitive training interventions with older adults: a randomized controlled trial. JAMA. 2002;288(18):2271–81.PubMedPubMedCentralCrossRef
98.
Willis SL, Tennstedt SL, Marsiske M, Ball K, Elias J, Koepke KM, et al. Long-term effects of cognitive training on everyday functional outcomes in older adults. JAMA. 2006;296(23):2805–14.PubMedPubMedCentralCrossRef
99.
Rebok GW, Ball K, Guey LT, Jones RN, Kim HY, King JW, et al. Ten-year effects of the advanced cognitive training for independent and vital elderly cognitive training trial on cognition and everyday functioning in older adults. J Am Geriatr Soc. 2014;62(1):16–24.PubMedPubMedCentralCrossRef
100.
Lampit A, Hallock H, Suo C, Naismith SL, Valenzuela M. Cognitive training-induced short-term functional and long-term structural plastic change is related to gains in global cognition in healthy older adults: a pilot study. Front Aging Neurosci. 2015;7:14.PubMedPubMedCentralCrossRef
101.
Smith GE, Housen P, Yaffe K, Ruff R, Kennison RF, Mahncke HW, et al. A cognitive training program based on principles of brain plasticity: results from the Improvement in Memory with Plasticity-based Adaptive Cognitive Training (IMPACT) study. J Am Geriatr Soc. 2009;57(4):594–603.PubMedPubMedCentralCrossRef
102.
Strenziok M, Parasuraman R, Clarke E, Cisler DS, Thompson JC, Greenwood PM. Neurocognitive enhancement in older adults: comparison of three cognitive training tasks to test a hypothesis of training transfer in brain connectivity. Neuroimage. 2014;85(Pt 3):1027–39.PubMedCrossRef
103.
Bahar-Fuchs A, Webb S, Bartsch L, Clare L, Rebok G, Cherbuin N, et al. Tailored and Adaptive Computerized Cognitive Training in Older Adults at Risk for Dementia: A Randomized Controlled Trial. J Alzheimers Dis. 2017;60(3):889–911.PubMedCrossRef
104.
Barnes DE, Yaffe K, Belfor N, Jagust WJ, DeCarli C, Reed BR, et al. Computer-based cognitive training for mild cognitive impairment: results from a pilot randomized, controlled trial. Alzheimer Dis Assoc Disord. 2009;23(3):205–10.PubMedPubMedCentralCrossRef
105.
Wiloth S, Werner C, Lemke NC, Bauer J, Hauer K. Motor-cognitive effects of a computerized game-based training method in people with dementia: a randomized controlled trial. Aging Ment Health. 2018;22(9):1124–35.PubMedCrossRef
106.
Chiu HL, Chu H, Tsai JC, Liu D, Chen YR, Yang HL, et al. The effect of cognitive-based training for the healthy older people: A meta-analysis of randomized controlled trials. PLoS One. 2017;12(5):e0176742.PubMedPubMedCentralCrossRef
107.
Lampit A, Hallock H, Valenzuela M. Computerized cognitive training in cognitively healthy older adults: a systematic review and meta-analysis of effect modifiers. PLoS Med. 2014;11(11):e1001756.PubMedPubMedCentralCrossRef
108.
Wiloth S, Werner C, Lemke NC, Bauer J, Hauer K. Motor-cognitive effects of a computerized game-based training method in people with dementia: a randomized controlled trial. Aging Ment Health. 2017:1–12.
109.
Fernandez-Gonzalo S, Turon M, Jodar M, Pousa E, Hernandez Rambla C, Garcia R, et al. A new computerized cognitive and social cognition training specifically designed for patients with schizophrenia/schizoaffective disorder in early stages of illness: A pilot study. Psychiatry Res. 2015;228(3):501–9.PubMedCrossRef
110.
Vermeij A, Kessels RPC, Heskamp L, Simons EMF, Dautzenberg PLJ, Claassen J. Prefrontal activation may predict working-memory training gain in normal aging and mild cognitive impairment. Brain Imaging Behav. 2017;11(1):141–54.PubMedCrossRef
111.
Adamski N, Adler M, Opwis K, Penner IK. A pilot study on the benefit of cognitive rehabilitation in Parkinson's disease. Ther Adv Neurol Disord. 2016;9(3):153–64.PubMedPubMedCentralCrossRef
112.
Conklin HM, Ashford JM, Clark KN, Martin-Elbahesh K, Hardy KK, Merchant TE, et al. Long-Term Efficacy of Computerized Cognitive Training Among Survivors of Childhood Cancer: A Single-Blind Randomized Controlled Trial. J Pediatr Psychol. 2017;42(2):220–31.PubMed
113.
Saleh AJ, Tang GX, Hadi SM, Yan L, Chen MH, Duan KM, et al. Preoperative cognitive intervention reduces cognitive dysfunction in elderly patients after gastrointestinal surgery: a randomized controlled trial. Med Sci Monit. 2015;21:798–805.PubMedPubMedCentralCrossRef
114.
Kulason K, Nouchi R, Hoshikawa Y, Noda M, Okada Y, Kawashima R. The Beneficial Effects of Cognitive Training With Simple Calculation and Reading Aloud (SCRA) in the Elderly Postoperative Population: A Pilot Randomized Controlled Trial. Front Aging Neurosci. 2018;10:68.PubMedPubMedCentralCrossRef
115.
Vlisides PE, Das AR, Thompson AM, Kunkler B, Zierau M, Cantley MJ, et al. Home-based Cognitive Prehabilitation in Older Surgical Patients: A Feasibility Study. J Neurosurg Anesthesiol. 2019;31(2):212–7.PubMedPubMedCentralCrossRef
116.
O'Gara BP, Mueller A, Gasangwa DVI, Patxot M, Shaefi S, Khabbaz K, et al. Prevention of Early Postoperative Decline: A Randomized, Controlled Feasibility Trial of Perioperative Cognitive Training. Anesth Analg. 2020;130(3):586–95.PubMedPubMedCentralCrossRef
117.
•• Humeidan ML, Reyes JC, Mavarez-Martinez A, Roeth C, Nguyen CM, Sheridan E, et al. Effect of Cognitive Prehabilitation on the Incidence of Postoperative Delirium Among Older Adults Undergoing Major Noncardiac Surgery: The Neurobics Randomized Clinical Trial. JAMA Surg. 2020; This important study demonstrated that even minimal participation in preoperative cognitive exercise lowers the risk of postoperative delirium. This prospective, single-blind, randomized clinical trial enrolled 268 older adults awaiting major noncardiac surgery and randomized them to a tablet-based cognitive exercise program targeting memory, speed, attention, flexibility, and problem-solving or to usual care. Participants who completed any cognitive exercise were less likely to develop delirium than those who did not.
Metadata
Title
Postoperative Delirium Prevention and Novel Cognitive Therapy Interventions
Authors
Kimberly F. Rengel
Christina S. Boncyk
Christopher G. Hughes
Publication date
01-03-2022
Publisher
Springer US
Published in
Current Anesthesiology Reports / Issue 1/2022
Electronic ISSN: 2167-6275
DOI
https://doi.org/10.1007/s40140-021-00501-1

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