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

项目总结/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非常普遍、病态和昂贵。它还与功能性 和认知障碍。没有特定的药理学治疗或方法来靶向特定的认知障碍。 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、发病率和谵妄持续时间。临床指南建议使用多组分、非 药理学策略集中于初级预防（即，在谵妄发生之前预防谵妄）， 精神错乱的风险。这些策略包括移动/锻炼，重新定向和认知刺激练习。 然而，传统的认知疗法给予外科重症监护病房（ICU）的病人是非特异性的， 定制，由于护理人员相关问题、文件负担、时间限制， 对支持认知刺激的证据缺乏理解或欣赏。虚拟现实（VR） 这是一项新兴技术，具有潜在的治疗作用，包括对重症患者进行认知刺激。VR 参与多个学习系统，使其成为一个更有效的自然环境， 对谵妄所涉及的特定认知领域的训练。我们开发了一个新颖的3D模拟软件平台， 原型，“ReCognition”VR，以解决这些缺点，提供基于VR的认知练习， 在一项试点研究中对患者进行测试。我们建议，“再认知”基于虚拟现实的认知干预将防止 谵妄的发展（在有谵妄风险的患者中发生之前），短期和长期认知 ICU收治的年龄> 60岁的危重、非通气腹部手术患者的损伤。 目的1：确定基于VR的“ReCognition”认知刺激的可行性、可用性和可接受性 目标2：评估试点成果指标（耐受性），以最佳实施“重新认知” 基于VR的认知刺激练习;目的3：评估以下试验性治疗有效性结局： “ReCognition”基于VR的认知刺激练习在预防谵妄、短期和长期认知 GEMSSTAR -R 03奖将支持当前的研究项目，并为我提供一个平台， 继续专注于基于老年的临床研究，并帮助我成为一个领导者和独立的 医生科学家进行临床研究的谵妄和谵妄后的认知障碍， 老年手术人群。这个奖项将专门为我提供所需的支持，以发展专业知识，在2 领域：（1）基于试点研究结果的基于VR的认知练习的修改（2） 基于VR的认知运动应用的可行性、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R 01，将为未来的临床试验奠定基础，解决预防策略或 老年外科病人谵妄的治疗。

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.