The proposed K23 program will allow Dr. Phillip E. Vlisides, an Assistant Professor of Anesthesiology at the University of Michigan Medical School, to establish an independent program of clinical neuroscience research that seeks to better understand and improve neurocognitive recovery following surgery and anesthesia. Based on emerging preliminary data, the central hypothesis is that distinct neurophysiologic patterns in the perioperative setting will predict postoperative neurocognitive recovery. To test this hypothesis, we propose an observational study to explore candidate neural biomarkers that may correlate with postoperative neurocognitive trajectory (Aims 1 and 2) followed by a clinical trial to test a behavioral intervention, cognitive prehabilitation, for improving postoperative neurocognitive function (Aim 3).
Specific Aim 1 is to characterize perioperative whole-scalp electroencephalographic (EEG) patterns in relation to postoperative recovery. We hypothesize that posterior EEG alpha power and frontal-parietal connectivity, analyzed in the postanesthesia care unit, will correlate with postoperative cognitive function. The candidate will learn advanced techniques of EEG acquisition and analysis that will be critical for designing such neurophysiologic studies in clinical neuroscience.
Specific Aim 2 is to measure perioperative regional cerebral oximetry (rSO2) in relation to advanced EEG patterns and cognitive recovery. We hypothesize that postoperative cerebral oximetry values will correlate with cognitive function after major surgery. In addition to the neurophysiologic training described, the candidate will receive education in cognitive testing and neuropsychology so that he can conduct sophisticated neurologic phenotyping of surgical patients. Lastly, Specific Aim 3 is to test the efficacy of cognitive prehabilitation on postoperative neurocognitive function. We hypothesize that preoperative cognitive prehabilitation (i.e., ?brain training?) will improve neurocognitive function in the postoperative period. For this last aim, the candidate will train in advanced clinical trial design and conduct in order to obtain the necessary skills to independently lead multicenter trials in the future. With this proposal, the candidate will be trained in cutting edge neuroscience research methods (e.g., advanced EEG techniques, calibrated cognitive function testing) and clinical trial design and conduct. He will thus be poised to lead large-scale efforts for better understanding and improving brain health in surgical patients.
Public Health Relevance: Approximately 40 million anesthetics are administered each year in the United States. The mechanisms by which patients regain cognitive function after general anesthesia are incompletely understood, and cognitive impairment (e.g., delirium, agitation) after surgery and anesthesia is a daily clinical challenge. Furthermore, there is a paucity of effective strategies for preventing such adverse neurologic outcomes. By better understanding and facilitating neurocognitive recovery after surgery and anesthesia, we may ultimately minimize the risk of postoperative cognitive impairment and associated complications.
| Vlisides, Phillip E; Das, Abhijit R; Thompson, Allie M et al. (2018) Home-based Cognitive Prehabilitation in Older Surgical Patients: A Feasibility Study. J Neurosurg Anesthesiol : |
