Preoperative Cognitive Intervention Reduces Cognitive Dysfunction in Elderly Patients after Gastrointestinal Surgery: A Randomized Controlled Trial
Amin J. Saleh, Guan-Xiu Tang, Sally M. Hadi, Liao Yan, Ming-Hua Chen, Kai-Ming Duan, Jianbin Tong, Wen Ouyang
Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
Med Sci Monit 2015; 21:798-805
Preoperative conditions may play a significant role in postoperative cognitive dysfunction (POCD) development in elderly patients. We aimed to investigate whether preoperative cognitive training could lower the incidence of POCD one week after surgery.
Material and Methods: A total of 141 ASA I-III elderly patients who underwent gastrointestinal surgery were enrolled into the study. Patients were randomized into either the Intervention group (69 analyzed) or the Control group (72 analyzed). Patients in the intervention group were instructed and trained in a cognition mnemonic skill for a total of three 1-hour sessions with the method of loci (MoL). Controls did not receive any cognitive training during hospitalization. All patients were tested using neuropsychological battery tests (NPTs) on admission and one week after surgery.
Results: The incidence of POCD in the intervention group (15.9%) was significantly lower than in the controls (36.1%) (P<0.05). Patients’ performance in Brief Visuospatial Memory Test-Revised and Symbol-Digit Modalities Test were improved by the cognitive training. Increasing age, longer length of anesthesia and surgery, and lack of cognitive training were associated with a significantly higher risk of POCD (P<0.05).
Conclusions: Cognitive training with MoL can reduce the decline of early postoperative cognitive function in elderly patients undergoing major gastrointestinal surgery.
Keywords: Cognition Disorders - physiopathology, Cognition, Digestive System Surgical Procedures - adverse effects, Follow-Up Studies, Postoperative Care, Postoperative Complications - etiology, Preoperative Care, Risk Factors