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Home-based Cognitive Prehabilitation in Older Surgical Patients

A Feasibility Study

Vlisides, Phillip E., MD*,†; Das, Abhijit R., BS; Thompson, Allie M., MS*; Kunkler, Bryan, MD*; Zierau, Mackenzie*; Cantley, Michael J., BS*; McKinney, Amy M., MA*; Giordani, Bruno, PhD§

Journal of Neurosurgical Anesthesiology: April 2019 - Volume 31 - Issue 2 - p 212–217
doi: 10.1097/ANA.0000000000000569
Clinical Investigations

Background: Cognitive training is beneficial in various clinical settings, although its perioperative feasibility and impact remain unknown. The objective of this pilot study was to determine the feasibility of home-based cognitive prehabilitation before major surgery in older adults.

Materials and Methods: Sixty-one patients were enrolled, randomized, and allocated to either a home-based preoperative cognitive training regimen or no training before surgery. Outcomes included postoperative delirium incidence (primary outcome; assessed with the 3D-Confusion Assessment Method), perioperative cognitive function based on NIH Toolbox measures, hospital length of stay, and physical therapy session participation. Reasons for declining enrollment were reported, as were reasons for opting out of the training program.

Results: Postoperative delirium incidence was 6 of 23 (26%) in the prehabilitation group compared with 5 of 29 (17%) in the control group (P=0.507). There were no significant differences between groups in NIH Toolbox cognitive function scoring, hospital length of stay, or physical therapy participation rates. Study feasibility data were also collected and reported. The most common reasons for declining enrollment were lack of computer access (n=19), time commitment (n=9), and feeling overwhelmed (n=9). In the training group, only 5 of 29 (17%) included patients were able to complete the prescribed 7 days of training, and 14 of 29 (48%) opted out of training once home. Most common reasons were feeling overwhelmed (n=4) and computer difficulties (n=3).

Conclusions: Short-term, home-based cognitive training before surgery is unlikely to be feasible for many older patients. Barriers to training include feeling overwhelmed, technical issues with training, and preoperative time commitment.

*Department of Anesthesiology

Center for Consciousness Science

§Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI

Northeast Ohio Medical University, Rootstown, OH

P.E.V. is supported by National Institutes of Health Grant K23GM126317. The study was also supported by the Department of Anesthesiology, University of Michigan Medical School (Ann Arbor, MI).

The methodology of this trial was presented as a poster presentation at the Foundation for Anesthesia Education and Research 2017 Medical Student Anesthesia Research Fellowship Symposium (MSARF Fellow: A.R.D.).

The authors have no funding or conflicts of interest to disclose.

Address correspondence to: Phillip E. Vlisides, MD, Department of Anesthesiology, University of Michigan Medical School, 1H247 UH, SPC-5048, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5048 (e-mail:

Received September 12, 2018

Accepted November 16, 2018

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