Preoperative cognitive exercises decrease postoperative delirium: Study Finds

Postoperative delirium in older adults is a common and costly complication after surgery. Cognitive reserve affects the risk of postoperative delirium, and thus preoperative augmentation of the reserve as a preventive technique is of vital interest.

Does preoperative cognitive exercise reduces the incidence of postoperative delirium in older adults undergoing major noncardiac surgery? a frequent question asked. Hence, to determine whether cognitive rehabilitation reduces the incidence of postoperative delirium among older adults, Michelle L. Humeidan and colleagues from the Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus conducted the present study.

The authors carried out a prospective, single-blinded randomized clinical trial at the Ohio State University Wexner Medical Center in Columbus which included a total of 699 patients out of which 322 completed consent and 268 were randomized. A total of 125 patients in the intervention group and 126 control patients were included in the final analysis. Patients 60 years and older undergoing major, noncardiac, non-neurological surgery under general anesthesia, with an expected hospital stay of at least 72 hours, were eligible for trial inclusion. Patients were excluded for preoperative cognitive dysfunction and active depression.

The primary outcome was the incidence of delirium between postoperative day 0 to day 7 or discharge, as measured by a brief Confusion Assessment Method, Memorial Delirium Assessment Scale, or a structured medical record review. Secondary outcomes compared delirium characteristics between patients in the intervention and control groups.

The key findings were-

1. Ninety-seven percent of the patients in the intervention group completed some brain exercise.
2. The delirium rate among control participants was 23.0% (29 of 126).
3. With intention-to-treat analysis, the delirium rate in the intervention group was 14.4% (18 of 125; P = .08).
4. Post hoc analysis removed 4 patients who did not attempt any cognitive exercise from the intervention group, yielding a delirium rate of 13.2% (16 of 121; P = .04).
5. Secondary analyses among patients with delirium showed no differences in postoperative delirium onset day or duration or total delirium-positive days across the study groups.

Therefore, the authors concluded by saying, "The intervention lowered delirium risk in patients who were at least minimally compliant. The ideal activities, timing, and effective dosage for cognitive exercise-based interventions to decrease postoperative delirium risk and burden need further study."