VR Training to Improve Postoperative Cognitive Function in Elderly Patients With Cerebral Small Vessel Disease Undergoing Non-Cardiac Surgery

NCT07370844 | Not Yet Recruiting DMC

• 1 other identifier: TY2025014
• Study Type: interventional
• Target: 240
• Locations: 1 country
• Sites: 3

Brief Summary

This clinical study aims to investigate whether virtual reality (VR)-based cognitive training can help improve postoperative cognitive function in elderly non-cardiac surgery patients with pre-existing cerebral small vessel disease (CSVD). As the global aging population undergoes an increasing number of surgical procedures, perioperative neurocognitive disorders (PND) have emerged as a serious complication among surgical patients, potentially prolonging hospital stays and increasing the risk of developing Alzheimer's disease. The study employs an innovative VR system that integrates eye-tracking cognitive assessment with interactive rehabilitation games to evaluate and train patients' cognitive function prior to non-cardiac and non-cranial surgeries. Conducted at Peking University Third Hospital, Peking University First Hospital, and Xuanwu Hospital of Capital Medical University, this research specifically targets patients undergoing general surgery, orthopedic surgery, and other non-cranial/non-cardiac procedures. It seeks to validate whether this technology-based intervention can effectively enhance postoperative cognitive function in this population while exploring its underlying mechanisms. The findings may offer a practical solution for protecting cognitive health in elderly patients during recovery from routine surgical procedures.

Conditions

Cerebral Small Vessel Disease; Postoperative Cognitive Function

Keywords

Cerebral Small Vessel Disease; Postoperative Cognitive Function; Postoperative Delirium; Virtual Reality

Outcome Measures

Primary Outcomes (1)

• Change in postoperative cognitive score from baseline

  Trained research personnel (certified by neurologists) administer the Montreal Cognitive Assessment (MoCA) to evaluate eight cognitive domains (visuospatial ability, executive function, memory, attention, calculation, language, abstract thinking, and orientation), with total scores ranging 0-30 (normal cognition defined as ≥26).We defined an increase in MoCA of ≥ 2 points as cognitive improvement

  At admission, on postoperative day 5 (or before discharge), and at 1, 6, and 12 months postoperatively

Secondary Outcomes (4)

• Occurrence of postoperative delirium

  From the first day to the fifth day after surgery or from the first day after surgery to before discharge

• Amplitude of Low-Frequency Fluctuation（ALFF） of brain regions

  At enrollment and immediately after completion of the preoperative intervention

• Fractional Amplitude of Low-Frequency Fluctuation（fALFF) of brain regions

  At enrollment and immediately after completion of the preoperative intervention

• Regional Homogeneity（ReHo） of brain regions

  At enrollment and immediately after completion of the preoperative intervention

Study Arms (2)

Preoperative Training Group

EXPERIMENTAL

Device: Virtual reality cognitive function training

Preoperative Non-Training Group

SHAM COMPARATOR

Device: Virtual scene intervention

Interventions

Virtual reality cognitive function training DEVICE

Participants will receive VR-based cognitive training over 4-5 days prior to surgery, with three daily 30-minute sessions (8:00-10:00 AM, 12:00-2:00 PM, and 5:00-7:00 PM), ensuring a total preoperative training duration ≥6 hours. The intervention utilizes an immersive VR environment that simulates real-world scenarios and tasks. Training modules target multiple cognitive domains, including memory, executive function, calculation, and abstract reasoning, designed as engaging, game-like activities with a gradual learning curve. Each participant's regimen is personalized based on baseline cognitive assessments or physician prescriptions, adhering to the "6-hour rule" for standardized efficacy evaluation. The system incorporates adaptive difficulty adjustment, dynamically modifying task complexity in response to real-time performance.

Preoperative Training Group

Virtual scene intervention DEVICE

The control group will receive non-interactive VR exposure using identical equipment and session duration as the training group (3×30-minute daily sessions for 4-5 days, totaling ≥6 hours), with all interactive functions disabled to eliminate potential media-related biases (e.g., 2D/3D cognitive load differences from tablet-based interventions) and ensure between-group differences stem solely from interactive training while maintaining blinding integrity through equivalent hardware deployment.

Preoperative Non-Training Group

Eligibility Criteria

• Age: 60 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age≥60;
• Preoperative MRI-confirmed cerebral small vessel disease;
• Scheduled to undergo non-cardiac, non-craniotomy procedures under general anesthesia;
• ASA physical status classification: I-III;
• No use of cognitive-enhancing medications within 3 months prior to surgery;
• Voluntary participation with signed informed consent

You may not qualify if:

• Contraindications to cranial MRI (e.g., cardiac pacemaker, metallic implants, etc.);
• Intolerance to VR equipment during pre-training adaptation (e.g., dizziness, nausea, vomiting, or other subjective discomfort);
• Severe visual or auditory impairment;
• Severe hepatic or renal dysfunction;
• Pre-existing neuropsychiatric disorders (e.g., schizophrenia, epilepsy, Parkinson's disease, or active delirium);
• Inability to complete preoperative neuropsychological assessments (e.g., dementia, deaf-mutism, or communication barriers);
• Use of sedatives, antidepressants, or history of psychoactive substance abuse/alcoholism

Sponsors & Collaborators

• Peking University Third Hospital: lead
• Peking University First Hospital: collaborator
• Xuanwu Hospital, Beijing: collaborator

Study Sites (3)

Peking University First Hospital

Beijing, China

Location

Peking University Third Hospital

Beijing, China

Location

Xuanwu Hospital

Beijing, China

Location

Related Publications (8)

• Chen CC, Li HC, Liang JT, Lai IR, Purnomo JDT, Yang YT, Lin BR, Huang J, Yang CY, Tien YW, Chen CN, Lin MT, Huang GH, Inouye SK. Effect of a Modified Hospital Elder Life Program on Delirium and Length of Hospital Stay in Patients Undergoing Abdominal Surgery: A Cluster Randomized Clinical Trial. JAMA Surg. 2017 Sep 1;152(9):827-834. doi: 10.1001/jamasurg.2017.1083.

  PMID: 28538964 RESULT

• de Vries NM, Staal JB, van der Wees PJ, Adang EM, Akkermans R, Olde Rikkert MG, Nijhuis-van der Sanden MW. Patient-centred physical therapy is (cost-) effective in increasing physical activity and reducing frailty in older adults with mobility problems: a randomized controlled trial with 6 months follow-up. J Cachexia Sarcopenia Muscle. 2016 Sep;7(4):422-35. doi: 10.1002/jcsm.12091. Epub 2015 Dec 4.

  PMID: 27239405 RESULT

• Kho W, von Haefen C, Paeschke N, Nasser F, Endesfelder S, Sifringer M, Gonzalez-Lopez A, Lanzke N, Spies CD. Dexmedetomidine Restores Autophagic Flux, Modulates Associated microRNAs and the Cholinergic Anti-inflammatory Pathway upon LPS-Treatment in Rats. J Neuroimmune Pharmacol. 2022 Jun;17(1-2):261-276. doi: 10.1007/s11481-021-10003-w. Epub 2021 Aug 6.

  PMID: 34357471 RESULT

• Aranake-Chrisinger A, Avidan MS. Postoperative delirium portends descent to dementia. Br J Anaesth. 2017 Aug 1;119(2):285-288. doi: 10.1093/bja/aex126. No abstract available.

  PMID: 28854545 RESULT

• Peden CJ, Miller TR, Deiner SG, Eckenhoff RG, Fleisher LA; Members of the Perioperative Brain Health Expert Panel. Improving perioperative brain health: an expert consensus review of key actions for the perioperative care team. Br J Anaesth. 2021 Feb;126(2):423-432. doi: 10.1016/j.bja.2020.10.037. Epub 2021 Jan 4.

  PMID: 33413977 RESULT

• Jin Z, Hu J, Ma D. Postoperative delirium: perioperative assessment, risk reduction, and management. Br J Anaesth. 2020 Oct;125(4):492-504. doi: 10.1016/j.bja.2020.06.063. Epub 2020 Aug 11.

  PMID: 32798069 RESULT

• Meara JG, Leather AJ, Hagander L, Alkire BC, Alonso N, Ameh EA, Bickler SW, Conteh L, Dare AJ, Davies J, Merisier ED, El-Halabi S, Farmer PE, Gawande A, Gillies R, Greenberg SL, Grimes CE, Gruen RL, Ismail EA, Kamara TB, Lavy C, Lundeg G, Mkandawire NC, Raykar NP, Riesel JN, Rodas E, Rose J, Roy N, Shrime MG, Sullivan R, Verguet S, Watters D, Weiser TG, Wilson IH, Yamey G, Yip W. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Int J Obstet Anesth. 2016 Feb;25:75-8. doi: 10.1016/j.ijoa.2015.09.006. Epub 2015 Sep 30. No abstract available.

  PMID: 26597405 RESULT

• Nijsse B, Visser-Meily JM, van Mierlo ML, Post MW, de Kort PL, van Heugten CM. Temporal Evolution of Poststroke Cognitive Impairment Using the Montreal Cognitive Assessment. Stroke. 2017 Jan;48(1):98-104. doi: 10.1161/STROKEAHA.116.014168. Epub 2016 Nov 29.

  PMID: 27899753 RESULT

MeSH Terms

Conditions

Cerebral Small Vessel Diseases; Emergence Delirium

Condition Hierarchy (Ancestors)

Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Delirium; Confusion; Neurobehavioral Manifestations; Neurologic Manifestations; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Neurocognitive Disorders; Mental Disorders

Study Officials

• Zhengqian Li, Principal Investigator

  Peking University Third Hospital

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Zhengqian Li, Associate Chief Physician

CONTACT

+86 156 1190 8458; zhengqianli@hsc.pku.edu.cn

Ziyuan Shen

CONTACT

+86 150 0220 8972; 15002208972@163.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Chief Physician

Model Details: A third-party statistician generated the allocation sequence using R 4.3.3 with a dynamic block design (mixed block sizes of 4 and 6), stratified by study site; the randomization scheme was uploaded to the REDCap system, where patient eligibility was verified before enrollment, and upon entering patient data into REDCap, the system automatically executed the stratified randomization.

Study Record Dates

• First Submitted: January 14, 2026
• First Posted: January 27, 2026
• Study Start: February 1, 2026
• Primary Completion (Estimated): November 30, 2027
• Study Completion (Estimated): December 31, 2027
• Last Updated: January 27, 2026

Record last verified: 2026-01

Data Sharing

• IPD Sharing: Will share

Locations

CN (3)