Researchers receive funding to study post-surgery delirium prevention in older adults

Despite improvements in recovery procedures and outcomes after cardiac surgery, impaired cognitive function is still a quite common complication. According to the National Center for Health Statistics, 2.6 million American adults over age 65 develop delirium each year and cardiac surgery patients are among the most at risk for postoperative delirium.

patient with physician

“That is why the development of effective neuroprotective strategies is key to ensuring patients have a chance at full recovery,” says Michelle Humeidan, MD, PhD, clinical associate professor of Anesthesiology at The Ohio State University College of Medicine.


She’s an expert on brain exercise for protection and augmentation of cognitive reserve before surgery. Cognitive reserve in patients is a significant contributor to risk of developing acute confusion or agitation, known as delirium, after surgery.


Funding support through the Patient-Centered Outcomes Research Institute for The SCOPE Trial: Sleep, Cognition, and Pain Bundle Versus Enhanced Recovery After Surgery-Cardiac for Postoperative Delirium, will team Dr. Humeidan with Molly McNett, PhD, RN, clinical professor of Nursing at The Ohio State University College of Nursing, and researchers at Beth Israel Deaconess Medical Center, Massachusetts General Hospital and Columbia University. 


Together, they’ll study a more comprehensive approach to increasing cognitive reserve with sleep hygiene and pain control, in addition to brain exercise, to try to prevent delirium in cardiac surgery patients. Dr. Humeidan will train all study sites to administer the brain exercise component of the trial which has patients receiving an electronic tablet preloaded with the brain exercise software. 


“They’ll be instructed to exercise their brain daily in the weeks leading up to surgery, with a goal ‘dose’ of 10 hours,” Dr. Humeidan says. “I’ll oversee data collection and analysis of patient compliance with the brain exercise, and help assess barriers to participation. This will help our team understand potential for broader implementation of study interventions in surgical populations.”


Dr. McNett will lead the study team using an implementation science approach to evaluate factors influencing routine use of the bundle of interventions across healthcare settings. She says this trial will address many cardiac surgery outcome-related questions commonly asked by patients.


“Questions like ‘are there exercises I can participate in that can improve my sleep, pain and mood after surgery?’ And ‘how can I best prepare before surgery to improve my long-term health and avoid disability?’” Dr. McNett says. “We’ll employ our experience to synthesize the research results to generate meaningful practice recommendations for health care teams.”


Dr. Humeidan, who also serves as medical director of Enhanced Surgical Recovery at The Ohio State University Wexner Medical Center, will also lead analysis of patient performance on the brain exercise as a marker of cognitive reserve, using her knowledge gained from an earlier study on the use of brain exercise in older patients before major surgery.


“The results of that trial indicated that pre-op brain exercise may lower delirium risk,” Dr. Humeidan says. “It supports the premise that ‘an active mind is a protected mind.’” 

According to Richard Urman, MD, MBA, professor and chair of the Department of Anesthesiology at the Ohio State College of Medicine, the five-year, $11.7 million research study will explore multiple interventions designed to increase cognitive reserve in this vulnerable patient population.  

“This important study has the potential to change our current practices and improve patient outcomes,” Dr. Urman says.    

This includes providing real-world evidence about the comparative effectiveness of different strategies to improve the prevention, early identification or treatment of delirium in older adults.    

“Determining if our approach of protecting — and maybe even growing — cognitive reserve could help patients better prepare for surgery,” Dr. Humeidan says. “And reach our goal of decreasing the risk of delirium in older patients having cardiac surgery.”