Prevention of Early Postoperative Decline

Not Applicable

Completed

Brief Summary: The purpose of this trial is to determine whether using a brain training program in the time leading up to as well as after heart surgery will reduce confusion and cognitive loss that can occur after surgery.

Detailed Description: Randomized, controlled pilot study with a convenience sample of 45 adult cardiac surgical patients. The main intervention to be studied will be the use of a neurocognitive training program (Lumosity) for 10 days preoperatively, and then for four weeks postoperatively. The prescribed regimen of training will focus on the areas of cognitive function most commonly affected in the postoperative period, including working memory, attention, and processing speed. Patients in the control arm will undergo current standard cardiac surgical postoperative care and will be asked to refrain from obtaining a Lumosity account.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Preexisting psychiatric illness
History of cerebrovascular event or seizure
Non English speakers
Baseline severe cognitive dysfunction including Alzheimer's, Parkinson's, or other severe forms of dementia
Significant visual impairment
Enrollment in another study involving cognition

Arm && Interventions

Group	Intervention	Description
Lumosity (CT Group)	Lumosity	Patients in the Lumosity arm will be prescribed a perioperative neurocognitive training program created in collaboration with Lumos Labs, Inc. The program will contain "brain games" that focus on enhancing cognitive abilities in working memory, attention, and processing speed. Participants will be expected to complete at least 2, but no more than 3, 15 minute sessions of training per day. The protocol will be prescribed for 10 days preoperatively, and then for four weeks postoperatively.

Primary Outcome Measures

Name	Time	Method
Feasibility of Providing a Neurocognitive Training Program to Elderly Cardiac Surgical Patients - Enrollment	Enrollment was assessed after enrollment was completed.	Feasibility will be partly determined by evaluating enrollment. Enrolling \>50% of eligible patients is the target.
Feasibility of Providing a Neurocognitive Training Program to Elderly Cardiac Surgical Patients - Adherence	To be evaluated at the conclusion of the study. Adherence was assessed in 3 separate periods: pre hospital, in hospital, and post discharge (typically at the 4 week follow up clinic visit).	Feasibility will be partly determined by evaluating adherence patterns. Sufficient adherence to protocol will be deemed sufficient to deem the study feasible.

Secondary Outcome Measures

Name	Time	Method
Number of Participants With Postoperative Delirium Measured by the Confusion Assessment Method (CAM)	Defined as present or absent on any day from postoperative day 1 to postoperative day 7.	Condition characterized by inattention and fluctuating consciousness. Measured by the Confusion Assessment Method (CAM). Inouye, S., van Dyck, C., Alessi, C., Balkin, S., Siegal, A. \& Horwitz, R. (1990). Clarifying confusion: The confusion assessment method. Annals of Internal Medicine, 113(12), 941-948.
Number of Participants With Postoperative Cognitive Decline	Day of hospital discharge, an average of 1 week.	Condition characterized by decrease in cognitive performance by one standard deviation after surgery, as compared to baseline. Measured by the Montreal Cognitive Assessment (MoCA).
Postoperative Cognitive Dysfunction Measured Using the Montreal Cognitive Assessment (MoCA)	Measured at 1, 3 and 6 months postoperatively.	Condition characterized by loss of cognitive function after surgery. Measured using the telephonic Montreal Cognitive Assessment (t-MoCA). The minimum score is 0, the maximum score is 22. The higher the score, the better the outcome.