Delirium Clinical Trial
Official title:
Perioperative Cognitive Protection - Cognitive Exercise and Cognitive Reserve (The Neurobics Trial)
NCT number | NCT02230605 |
Other study ID # | 2013H0388 |
Secondary ID | |
Status | Completed |
Phase | N/A |
First received | |
Last updated | |
Start date | July 2015 |
Est. completion date | August 20, 2019 |
Verified date | September 2019 |
Source | Ohio State University |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Many individuals experience an acute change in thinking and reasoning skills after surgery.
This is called post-operative delirium (PD). PD symptoms typically start 1-3 days after
surgery. Advanced age has been identified as a risk factor for PD. The purpose of this study
is to determine if performing mental exercise, before surgery, will help reduce post-surgery
memory and thinking problems. Assuming a 30% incidence of PD and proposed 50% reduction of PD
in the intervention group (15% incidence), a total of 242 patients (1:1 ratio, 121 in each
group) will achieve 80% power to detect 50% reduction using chi-square test at a 5% type I
error rate. Assuming approximately 1/3 of consented patients either fail screening or do not
complete the study after consent, we expect to consent 358 patients.
At least 8 days before surgery, subjects complete a series of questionnaires to assess
baseline cognition level (or thinking ability) and status of overall well-being. At the
completion of the screening visit, qualifying subjects are randomized into two groups:
Participants randomized into the Cognitive Exercise group are expected to complete
tablet-based brain games provided by Lumosity. These subjects are given a handheld tablet for
the duration of the preoperative period. Participants in this group are expected to complete
a minimum of 10 hours within at least 8 days prior to surgery.
Participants randomized into the Normal Activity group are encouraged to carry out their
baseline daily activities, and do not have any study-related cognitive exercise expectations
before surgery. These subjects still complete the same questionnaires and assessments as the
Cognitive Exercise group throughout the study, however, are asked not to alter their normal
daily routine of mental exertion (i.e. watching television, reading, puzzles, etc.) and are
not permitted to subscribe to Lumosity while in the research study.
On the day of surgery, a baseline delirium evaluation (CAM - Confusion Assessment Method) is
taken before surgery. During surgery, research personnel monitor vital signs and medications
given. After surgery, another CAM evaluation is taken in the post-operative recovery room.
Throughout the subject's hospital stay, pain levels and medication usage are recorded. The
CAM and MDAS (Memorial Delirium Assessment Scale) are used to identify and determine severity
of PD. The evaluations are given twice daily, at at 7:30AM ± 1.5 hrs and 6:30PM ± 1.5 hrs,
for 7 days or until hospital discharge (whichever comes first). The Postoperative Quality of
Recovery Scale (PQRS) is used each post-operative day at 6:30PM ± 1.5 hrs until discharge,
and completed over the phone on POD 7 if patient discharged. The PQRS is also administered
over the phone on POD 30 and POD 90.
Status | Completed |
Enrollment | 322 |
Est. completion date | August 20, 2019 |
Est. primary completion date | May 20, 2019 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | All |
Age group | 60 Years and older |
Eligibility |
Inclusion Criteria 1. 60 years of age or older 2. Capable and willing to consent 3. Non-cardiac/non-neurological surgery with expected hospital stay of at least 72 H 4. American Society of Anesthesiologists (ASA) physical status I-IV 5. English speaking 6. Willingness to use a provided tablet device 7. Willingness to commit at least 1 hour per day to experimental intervention (cognitive activity/exercise) to complete a minimum of 10 hours within at least 8 days prior to surgery. Exclusion criteria 1. Severe visual or auditory deficits 2. Illiterate 3. Surgery within the previous 6 months requiring general anesthesia 4. Score < 26 on initial Mini Mental Status Exam (MMSE - modified version) (24 for patients with less than high school education) 5. Positive pre-surgery Confusion Assessment Method test (CAM) 6. Active depression as indicated by Geriatric Depression Scale screening test (score = 10) 7. History of Axis I or II psychiatric disorders including bipolar disorder, schizophrenia, dementia, alcohol or drug abuse 8. ASA physical status V, VI 9. Planned postoperative intubation |
Country | Name | City | State |
---|---|---|---|
United States | The Ohio State University Wexner Medical Center | Columbus | Ohio |
Lead Sponsor | Collaborator |
---|---|
Ohio State University |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Reduction in the incidence of Post-Operative Delirium (%) | Assuming a 30% incidence of PD and proposed 50% reduction of PD in the intervention group (15% incidence), a total of 242 patients (1:1 ratio, 121 in each group) will achieve 80% power to detect 50% reduction using chi-square test at a 5% type I error rate. Assuming approximately 1/3 of consented patients either fail screening or do not complete the study after consent, we expect to consent 358 patients. The incidence of PD will be compared between the control group and the intervention group as detected by the Confusion Assessment Method (CAM) / Memorial Delirium Assessment Scale (MDAS). Once a patient is positive, they will no longer be assessed. | Post-Operative Period (Day 0 through Day 7 or Discharge, whichever comes first) |
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