- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04493996
Increasing Preoperative Cognitive Reserve to Prevent Postoperative Cognitive Dysfunction in Cardiac Surgical Patients (INCORE)
February 27, 2024 updated by: Heart and Brain Research Group, Germany
Increasing Preoperative Cognitive Reserve to Prevent Postoperative Delirium and Postoperative Cognitive Decline in Cardiac Surgical Patients. A Randomized Controlled Trial on Cognitive Training
Postoperative delirium (POD) and postoperative cognitive decline (POCD) can be observed after cardiosurgical interventions.
Taken together, these postoperative neurocognitive dysfunctions contribute to increased morbidity and mortality and higher economic costs.
Preoperative risk factors of postoperative neurocognitive dysfunctions, such as decreased neuropsychometric performance or decreased cognitive daily activities, can be interpreted as reduced cognitive reserve.
The aim of this study is to build up cognitive reserves to protect against the development of POD and POCD through preoperative, home-based, cognitive training.
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Detailed Description
The planned research project is a monocentric, 2-arm randomized controlled intervention study involving 100 patients undergoing elective cardiac surgery with extracorporeal circulation.
Patients will be assigned to a training group or control group.
The intervention involves a standardized, paper-and-pencil-based cognitive training that will be performed by the patients at home for approximately 40 minutes per day over a preoperative period of 2-3 weeks.
The control group will receive neither cognitive training nor a placebo intervention.
A detailed assessment of psychological functions will be performed approximately 2-3 weeks before the start of training, at the end of the training, during hospitalization, at discharge from the acute clinic, and 3 months after surgery.
The primary objective of this study is to investigate the interventional effect of preoperative cognitive training on the incidence of POD during the stay in the acute clinic, the incidence of POCD at the time of discharge from the acute clinic, and 3 months after surgery.
Secondary objectives are to determine the training effect on objective cognitive functions before the surgery and subjective cognitive functions, as well as health-related quality of life 3 months after surgery.
Study Type
Interventional
Enrollment (Estimated)
100
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Marius Butz, Dipl.-Psych.
- Phone Number: +496032 996 5812
- Email: m.butz@kerckhoff-klinik.de
Study Contact Backup
- Name: Martin Jünemann, Dr.med,M.Sc.
- Phone Number: +49641 98558917
- Email: Martin.Juenemann@neuro.med.uni-giessen.de
Study Locations
-
-
-
Bad Nauheim, Germany, 61231
- Recruiting
- Department of Cardiac Surgery, Kerckhoff-Klinik GmbH
-
Contact:
- Marius Butz
- Phone Number: +496032 996 5812
- Email: m.butz@kerckhoff-klinik.de
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
16 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Elective cardiac surgery (coronary artery bypass surgery, aortic or mitral valve replacement/reconstruction, or combination surgery) with standardized extracorporeal circulation
- A sufficiently good knowledge of German is necessary as cognitive training and neuropsychological tests are language-dependent
Exclusion Criteria:
- History of stroke and preexisting psychiatric or neurological disorders that may impair the neuropsychological performance
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Control group
|
|
Experimental: Cognitive training group
|
The cognitive training involves a standardized, paper-and-pencil-based cognitive training that will be performed by the patients at home for approximately 40 minutes per day over a preoperative period of 2-3 weeks
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of participants with postoperative cognitive decline at 3 months after surgery, defined as a decrease between pre- and postoperative examinations of one standard deviation in at least 20% of all objective neuropsychological parameters
Time Frame: Immediately pre-training to 3 month post-surgery
|
The objective neuropsychological parameters measure cognitive domains like Immediate memory span, free recall, recognition memory, selective attention, working memory, inhibition and word fluency.
These cognitive domains will be measured with the following instruments: "Verbaler Lern- und Merkfähigkeitstest" (VLMT), "Brief Visuospatial Memory Test-Revised" (BVMT-R), "Trail Making Test A/B" (TMT), "Letter Number Span Test" (LNS), "Regensburger Wortflüssigkeits-Test" (RWT), and "Syndrom-Kurz Test" (SKT-7).
|
Immediately pre-training to 3 month post-surgery
|
Number of participants with postoperative cognitive decline at the time of discharge from the acute clinic, defined as a decrease between the pre- and postoperative examinations of one standard deviation measured with the "Montreal Cognitive Assessment"
Time Frame: Immediately pre-training to approximately 1 week post-surgery
|
The "Montreal Cognitive Assessment" (MOCA) is a screening procedure for general cognitive function.
|
Immediately pre-training to approximately 1 week post-surgery
|
Number of participants with postoperative delirium during the stay in the intensive care unit as assessed using the "Intensive Care Delirium Screening Checklist" (ICDSC)
Time Frame: Immediately post-surgery to approximately 1-2 days post-surgery
|
Postoperative delirium is defined as the occurrence of at least one delirious episode during a stay in the intensive care unit.
The "Intensive Care Delirium Screening Checklist" (ICDSC) record the clinical symptoms of consciousness, attention, orientation, hallucinations, psychomotor retardation or agitation, speech, and changing symptoms by observing behavior and asking concrete questions to the patient.
|
Immediately post-surgery to approximately 1-2 days post-surgery
|
Number of participants with postoperative delirium during the stay on normal ward as assessed using the "Confusion Assessment Method" (3D-CAM)
Time Frame: Approximately 1 week (Immediately post-intensive care unit to approximately 1 week post-intensive care unit)
|
Postoperative delirium is defined as the occurrence of at least one delirious episode during a stay in an intensive care unit or normal ward.
The "Confusion Assessment Method" (3D-CAM) record the clinical symptoms of consciousness, attention, orientation, hallucinations, psychomotor retardation or agitation, speech, and changing symptoms by observing behavior and asking concrete questions to the patient.
|
Approximately 1 week (Immediately post-intensive care unit to approximately 1 week post-intensive care unit)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change from baseline cognitive failures in everyday life at 3 months after surgery as assessed using the "Cognitive Failures Questionnaire" (CFQ)
Time Frame: Immediately pre-training to 3 month post-surgery
|
The "Cognitive Failures Questionnaire" (CFQ) measure the frequency of failures in daily living in terms of memory, attention, action, and perception.
|
Immediately pre-training to 3 month post-surgery
|
Change from baseline health-related quality of life at 3 months after surgery as assessed using the "36-Item Short Form Health Survey" (SF36)
Time Frame: Immediately pre-training to 3 month post-surgery
|
The "36-Item Short Form Health Survey" (SF36) includes 36 questions covering 8 health-related factors: vitality, physical functioning, bodily pain, general health perception, physical role function, emotional role function, social role functioning, and mental health.
|
Immediately pre-training to 3 month post-surgery
|
Change from baseline visual immediate memory span at the end of cognitive training as assessed using the "Brief Visuospatial Memory Test-Revised" (BVMT-R)
Time Frame: Immediately pre-training to approximately 2-3 weeks post-training
|
In the "Brief Visuospatial Memory Test-Revised" (BVMT-R), the patient is shown six geometric figures for 10 seconds on a DIN A4 sheet of paper, which are to be drawn directly afterward.
This procedure is repeated with the same figures in a total of three learning trials.
The figures are to be freely replicated in a time-delayed episode with following recognition help.
|
Immediately pre-training to approximately 2-3 weeks post-training
|
Change from baseline visual free recall at the end of cognitive training as assessed using the "Brief Visuospatial Memory Test-Revised" (BVMT-R)
Time Frame: Immediately pre-training to approximately 2-3 weeks post-training
|
In the "Brief Visuospatial Memory Test-Revised" (BVMT-R), the patient is shown six geometric figures for 10 seconds on a DIN A4 sheet of paper, which are to be drawn directly afterward.
This procedure is repeated with the same figures in a total of three learning trials.
The figures are to be freely replicated in a time-delayed episode with following recognition help.
|
Immediately pre-training to approximately 2-3 weeks post-training
|
Change from baseline visual recognition memory at the end of cognitive training as assessed using the "Brief Visuospatial Memory Test-Revised" (BVMT-R)
Time Frame: Immediately pre-training to approximately 2-3 weeks post-training
|
In the "Brief Visuospatial Memory Test-Revised" (BVMT-R), the patient is shown six geometric figures for 10 seconds on a DIN A4 sheet of paper, which are to be drawn directly afterward.
This procedure is repeated with the same figures in a total of three learning trials.
The figures are to be freely replicated in a time-delayed episode with following recognition help.
|
Immediately pre-training to approximately 2-3 weeks post-training
|
Change from baseline verbal immediate memory span at the end of cognitive training as assessed using the "Verbaler Lern- und Merkfähigkeitstest" (VLMT)
Time Frame: Immediately pre-training to approximately 2-3 weeks post-training
|
In the "Verbaler Lern- und Merkfähigkeitstest" (VLMT), a list of words is learned over five learning trials, which, after a interference word list, is to be remembered directly and with a delay of about 20 minutes.
With subsequent recognition help, the verbal discrimination ability is measured.
|
Immediately pre-training to approximately 2-3 weeks post-training
|
Change from baseline verbal free recall at the end of cognitive training as assessed using the "Verbaler Lern- und Merkfähigkeitstest" (VLMT)
Time Frame: Immediately pre-training to approximately 2-3 weeks post-training
|
In the "Verbaler Lern- und Merkfähigkeitstest" (VLMT), a list of words is learned over five learning trials, which, after a interference word list, is to be remembered directly and with a delay of about 20 minutes.
With subsequent recognition help, the verbal discrimination ability is measured.
|
Immediately pre-training to approximately 2-3 weeks post-training
|
Change from baseline verbal recognition memory at the end of cognitive training as assessed using the "Verbaler Lern- und Merkfähigkeitstest" (VLMT)
Time Frame: Immediately pre-training to approximately 2-3 weeks post-training
|
In the "Verbaler Lern- und Merkfähigkeitstest" (VLMT), a list of words is learned over five learning trials, which, after a interference word list, is to be remembered directly and with a delay of about 20 minutes.
With subsequent recognition help, the verbal discrimination ability is measured.
|
Immediately pre-training to approximately 2-3 weeks post-training
|
Change from baseline selective attention at the end of cognitive training as assessed using the "Trail Making Test A" (TMT)
Time Frame: Immediately pre-training to approximately 2-3 weeks post-training
|
In the "Trail Making Test A" (TMT-A), the patient has to connect numbers in ascending order on a test sheet as fast as possible.
|
Immediately pre-training to approximately 2-3 weeks post-training
|
Change from baseline verbal working memory at the end of cognitive training as assessed using the "Letter Number Span Test" (LNS)
Time Frame: Immediately pre-training to approximately 2-3 weeks post-training
|
In the "Letter Number Span Test" (LNS), the patient is supposed to rearrange a mixed sequence of letters and numbers through mental reorganization in such a way that first all numbers and then all letters are to be named in ascending order.
|
Immediately pre-training to approximately 2-3 weeks post-training
|
Change from baseline cognitive flexibility at the end of cognitive training as assessed using the "Trail Making Test B" (TMT)
Time Frame: Immediately pre-training to approximately 2-3 weeks post-training
|
With the "Trail Making Test B" (TMT-B), the patient's task is to connect numbers and letters alternately in ascending order.
|
Immediately pre-training to approximately 2-3 weeks post-training
|
Change from baseline inhibition at the end of cognitive training as assessed using the "Syndrom-Kurz Test" (SKT-7)
Time Frame: Immediately pre-training to approximately 2-3 weeks post-training
|
In the "Syndrom-Kurz Test" (SKT-7), the patient has to rename a series of letters (e.g., "A" instead of "B," and vice versa).
|
Immediately pre-training to approximately 2-3 weeks post-training
|
Change from baseline word fluency at the end of cognitive training as assessed using the "Regensburger Wortflüssigkeits-Test" (RWT)
Time Frame: Immediately pre-training to approximately 2-3 weeks post-training
|
In the "Regensburger Wortflüssigkeits-Test" (RWT), the patient has to name in one minute as many words as possible from a certain category.
|
Immediately pre-training to approximately 2-3 weeks post-training
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Marius Butz, Dipl.-Psych., Department of Cardiac Surgery, Kerckhoff Clinic Bad Nauheim
- Principal Investigator: Martin Jünemann, Dr.med,M.Sc., Clinic for Neurology, University Hospital Gießen
- Principal Investigator: Tibo Gerriets, Prof.Dr.med., Department of Neurology, Gesundheitszentrum Wetterau
- Principal Investigator: Markus Schönburg, Prof.Dr.med., Department of Cardiac Surgery, Kerckhoff Clinic Bad Nauheim
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
August 14, 2020
Primary Completion (Estimated)
October 1, 2025
Study Completion (Estimated)
December 1, 2025
Study Registration Dates
First Submitted
July 21, 2020
First Submitted That Met QC Criteria
July 30, 2020
First Posted (Actual)
July 31, 2020
Study Record Updates
Last Update Posted (Actual)
February 28, 2024
Last Update Submitted That Met QC Criteria
February 27, 2024
Last Verified
February 1, 2024
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 48/20
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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