Takeaway
- Older adults undergoing major surgery were less likely to develop postoperative delirium if they performed brain exercises in the weeks leading up to surgery.
Why this matters
- Postoperative delirium is common in this age group, and it slows recovery and increases morbidity and mortality.
Key results
- 97% of intervention patients completed some brain exercise (median, 4.6 hours out of goal of 10 hours).
- Postoperative delirium intervention group vs control group:
- Intention-to-treat analysis:
- Incidence, 14.4% vs 23.0% (P=.08).
- Multivariate relative risk, 0.58 (P=.047).
- On-treatment analysis:
- Incidence, 13.2% vs 23.0% (P=.04).
- Intention-to-treat analysis:
- Among patients with delirium, groups were similar for:
- Onset day.
- Delirium duration.
- Total delirium-positive days.
Study design
- US randomized controlled trial (Neurobics trial) among 268 adults aged ≥60 (median, 67) years:
- Normal baseline cognition.
- Undergoing major, noncardiac, nonneurological surgery with general anesthesia.
- Expected hospital stay of ≥72 hours.
- Randomization: normal daily activity (control group) vs electronic, tablet-based preoperative cognitive exercise targeting memory, speed, attention, flexibility, problem-solving functions (intervention).
- Main outcome: delirium between postoperative day 0 to day 7 or discharge.
- Funding: Ohio State University Department of Anesthesiology and Neuroscience Research Institute.
Limitations
- Completed hours of brain exercise estimated from number of games played.
- Unmeasured and residual confounding.
- Unknown generalizability.
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