Investigating Functional Outcomes and Cognition thrU Surgery (InFOCUS) study
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Project Summary Cognitive decline with aging, including Alzheimer’s Disease and Related Dementias (ADRD), is a public health imperative that impacts quality of life and disability. Survivors of acute surgical or medical illness contribute greatly to the crisis of cognitive decline. Hospitalization confers a 1.5-2-fold increase in the odds of new onset dementia. Surgery is common in older adults, but it (and its resulting hospitalization) is associated with significant cognitive decline. Individual interventions to reduce this decline have exhibited limited success. The COgnitive and Physical Exercise to improve Outcomes after Surgery (COPE-iOS) study is evaluating a program of cognitive and physical training throughout the perioperative period. The intervention consists of adaptive computerized cognitive training plus guided aerobic exercise sessions, whereas the active attention control consists of a non-adaptive control computer game and guided stretching sessions. Comprising both prehabilitation and rehabilitation, the two study arms participate in activities for at least 2 weeks prior to surgery and for 3 months after discharge and involve significant weekly interaction with our study team. The study assesses global cognition, disability, depression, and mechanistic pathways. Multiple additional factors, including social support, may influence postoperative recovery, and organized support groups empower patients are associated with improved outcomes after surgery. Throughout the COPE-iOS study, participants in both arms consistently engage with a core team of personnel and sessions are group-based, allowing participants to engage with and support one another. This design provides a much higher level of interaction with providers and peers facing similar circumstances than standard perioperative care. While the active attention control design is essential to the COPE-iOS study to evaluate the efficacy of the cognitive and physical exercise program, the active attention control may confer more benefit to patients than previously anticipated. The Investigating Functional Outcomes and Cognition thrU Surgery (InFOCUS) study is a prospective observational cohort measuring cognitive and physical outcomes after major surgery in older adults who are receiving usual care. The primary hypothesis of this proposal is that outcomes in usual care will be worse than both a combined cognitive and physical exercise program and an active attention control program with regard to global cognition (Aim 1) and disabilities and depression (Aim 2). The InFOCUS study will enroll 125 patients ≥60 years old awaiting major inpatient surgery and assess global cognition, activities of daily living, and depression at baseline and at 3 and 12 months after discharge to allow better understanding of the efficacy of the combined cognitive and physical exercise program and further our knowledge on potential contributions of enhanced systemic support around major surgery to improve outcomes when compared to usual care.
