Virtual Reality-Based Cognitive Intervention For The Prevention of Delirium & Cognitive Impairment In Geriatric Surgical Patients

基于虚拟现实的认知干预预防谵妄

• 批准号: 10689127
• 负责人: Hina Faisal
• 金额: $ 16.15万
• 依托单位: METHODIST HOSPITAL RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10689127
• 关键词: 3-Dimensional; Abdomen; Acute; Address; Admission activity; Adverse event; Age; Aging; Animal Model; Area; Asthenopia; Attention; Award; Awareness; Blurred vision; Brain; Clinical; Clinical Practice Guideline; Clinical Research; Clinical Trials; Cognition; Cognitive; Cognitive Therapy; Cognitive deficits; Computer software; Critical Illness; Data; Delirium; Development; Documentation; Early treatment; Elderly; Emerging Technologies; Environment; Exercise; Family member; Foundations; Frequencies; Future; Guidelines; Healthcare; Impaired cognition; Incidence; Intensive Care Units; Intervention; Intervention Studies; Lead; Learning; Length; Memory; Methods; Modification; Morbidity - disease rate; Music; Nausea; Nursing Staff; Operative Surgical Procedures; Outcome; Outcome Measure; Patients; Physical therapy; Physicians; Pilot Projects; Population; Prevalence; Prevention; Prevention strategy; Prevention therapy; Preventive; Primary Prevention; Randomized, Controlled Trials; Recommendation; Relaxation; Research; Research Project Grants; Resources; Risk; Role; Scientist; Structure; Surgical Intensive Care; Syndrome; System; Techniques; Testing; Therapeutic; Time; Training Programs; Treatment Effectiveness; Vomiting; aging brain; cognitive function; cognitive training; cost; cost effective; cybersickness; design; digital platform; effectiveness outcome; executive function; functional disability; healthcare acceptability; hospital care; human model; improved; innovation; mortality; neural; neurocognitive disorder; neuroregulation; novel; pharmacologic; prevent; processing speed; prototype; usability; virtual reality; virtual reality game

PROJECT SUMMARY/ABSTRACT Delirium is an acute fluctuating syndrome of altered attention, awareness, and cognition. Delirium is highly prevalent, morbid, and costly in elderly critically ill surgical patients. It is also associated with functional and cognitive impairment. No specific pharmacological therapy or approach exists to target the specific cognitive domain involved in delirium. However, early cognitive and physical therapy has been shown to decrease the cognitive deficit, incidence, and duration of delirium. Clinical guidelines recommend multi-component, non- pharmacologic strategies focused on primary prevention (i.e., preventing delirium before it occurs) in patients at risk for delirium. These strategies include mobility/exercise, re-orientation, and cognitive stimulation exercises. Nevertheless, traditional cognitive therapy given to surgical intensive care unit (ICU) patients is non–specific, not customized, and not prioritized due to nursing staff-related issues, documentation burden, time constraints, and a lack of understanding or appreciation for the evidence supporting cognitive stimulation. Virtual Reality (VR) is an emerging technology with potential therapeutic including cognitive stimulation in critically ill patients. VR engages multiple learning systems, making it a more effective natural environment and targeting cognitive training to specific cognitive domains involved in delirium. We developed a novel, 3D simulated software platform prototype, "ReCognition" VR, to address these shortcomings to provide VR-based cognitive exercises to patients for testing in a pilot study. We propose that "ReCognition" VR -based cognitive intervention will prevent the development of delirium (before it occurs in patients at risk for delirium), short term & long-term cognitive impairment in critically ill, non-ventilated abdominal surgery patients of age > 60 years admitted to the ICU. Aim 1: To determine the feasibility, usability & acceptability of "ReCognition" VR-based cognitive stimulation exercises; Aim 2: To assess pilot outcomes measures (tolerability) for optimal implementation of "ReCognition" VR-based cognitive stimulation exercises; Aim 3: To evaluate pilot treatment effectiveness outcomes of "ReCognition" VR-based cognitive stimulation exercises in preventing delirium, short and long-term cognitive impairment.The GEMSSTAR -R03 award will support a current research project and provide a platform for me to continue focusing on geriatric-based clinical research and help me become a leader and an independent physician-scientist to perform clinical research on the delirium and post-delirium cognitive impairment in the elderly surgical population. This award will specifically provide me the support needed to develop expertise in 2 areas: (1) Modification of Recognition VR based cognitive exercise based on the result of the pilot study (2) Preliminary data on feasibility, acceptability, and tolerability for the application of VR- based cognitive exercise for the prevention of delirium and cognitive impairment in a subsequent larger clinical trial. This proposal, and the subsequent planned R01, will lay the foundation for future clinical trials addressing prevention strategies or therapy for delirium in elderly surgical patients.

项目概要/摘要 谵妄是一种注意力、意识和认知改变的急性波动综合征。谵妄是 在老年危重外科患者中，该病非常普遍、致病且费用昂贵。也与功能性有关 和认知障碍。不存在针对特定认知的特定药物疗法或方法 涉及谵妄的领域。然而，早期认知和物理治疗已被证明可以减少 认知缺陷、谵妄的发生率和持续时间。临床指南推荐多成分、非 药物策略侧重于患者的一级预防（即在谵妄发生之前预防谵妄） 谵妄的风险。这些策略包括活动/锻炼、重新定位和认知刺激练习。 然而，针对外科重症监护病房（ICU）患者的传统认知疗法是非特异性的，不是 定制的，并且由于护理人员相关问题、文件负担、时间限制以及 对支持认知刺激的证据缺乏理解或欣赏。虚拟现实（VR）是 一种具有潜在治疗作用的新兴技术，包括对危重患者进行认知刺激。虚拟现实 涉及多个学习系统，使其成为更有效的自然环境并针对认知 对与谵妄有关的特定认知领域进行训练。我们开发了一种新颖的 3D 模拟软件平台 原型“ReCognition”VR，旨在解决这些缺点，提供基于 VR 的认知练习 患者在试点研究中进行测试。我们建议基于 VR 的“ReCognition”认知干预将防止 谵妄的发展（在有谵妄风险的患者发生之前）、短期和长期认知 年龄 > 60 岁入住 ICU 的危重非通气腹部手术患者的损伤。 目标 1：确定基于 VR 的认知刺激“ReCognition”的可行性、可用性和可接受性 练习；目标 2：评估试点结果措施（耐受性），以优化实施“ReCognition” 基于VR的认知刺激练习；目标 3：评估试点治疗效果 “ReCognition”基于 VR 的认知刺激练习可预防谵妄、短期和长期认知 GEMSSTAR -R03 奖将支持当前的研究项目并为我提供一个平台 继续专注于老年临床研究并帮助我成为领导者和独立的人 医师科学家对谵妄和谵妄后认知障碍进行临床研究 老年手术人群。该奖项将专门为我提供在以下方面发展专业知识所需的支持： 领域：(1) 根据试点研究结果修改基于 VR 的认知练习 (2) 基于VR的认知练习应用的可行性、可接受性和耐受性的初步数据 在随后的更大规模的临床试验中用于预防谵妄和认知障碍。这项提议，以及 随后计划的 R01 将为未来解决预防策略或 老年手术患者谵妄的治疗。