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

项目摘要/摘要 精神错乱是一种注意力、意识和认知改变的急性波动综合征。精神错乱是 在老年危重外科患者中非常普遍、病态和昂贵。它还与Function 和认知障碍。不存在针对特定认知的特定药物疗法或方法 涉及精神错乱的领域。然而，早期的认知和物理治疗已被证明可以减少 精神错乱的认知缺陷、发生率和持续时间。临床指南建议使用多组分、非 药物策略侧重于初级预防(即，在精神错乱发生之前预防)。 有精神错乱的危险。这些策略包括活动/锻炼、重新定向和认知刺激练习。 然而，对外科重症监护病房(ICU)患者进行的传统认知治疗是非特异性的，不是 由于护理人员相关问题、文档负担、时间限制以及 缺乏对支持认知刺激的证据的理解或欣赏。虚拟现实(VR)是 一种新兴技术，具有潜在的治疗作用，包括对危重患者的认知刺激。虚拟现实 使用多个学习系统，使其成为更有效的自然环境和目标认知 对涉及精神错乱的特定认知领域的训练。我们开发了一个新颖的三维仿真软件平台 原型“识别”VR，以解决这些缺点，以提供基于VR的认知练习 患者在一项试点研究中进行测试。我们认为，基于VR的认知干预将防止 精神错乱的发展(在有精神错乱风险的患者发生之前)、短期和长期认知 住进ICU的60岁的危重、非呼吸机腹部手术患者的损害。 目的1：确定基于虚拟现实的认知刺激的可行性、可用性和可接受性 练习；目标2：评估最佳执行“承认”的试点成果措施(容忍度) 基于VR的认知刺激练习；目标3：评估先导性治疗效果结果 基于VR的认知刺激练习预防妄想、短时和长期认知障碍 残疾。GEMSSTAR-R03奖将支持当前的研究项目，并为我提供一个平台 继续专注于以老年为基础的临床研究，帮助我成为领导者和独立的 内科医生和科学家将对精神错乱和精神错乱后认知障碍进行临床研究 老年外科手术人群。这一奖项将特别为我提供所需的支持，以发展2 领域：(1)根据先导研究的结果修改基于虚拟现实的认知练习(2) 基于VR的认知训练应用的可行性、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精神错乱和认知障碍。这项建议，以及 随后计划的R01将为未来的临床试验奠定基础，以解决预防策略或 老年外科患者精神障碍的治疗。

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.