Virtual Reality-Based Cognitive Stimulation Games for Enhancing Attention and Preventing Delirium in Older Surgical Patients with Cognitive Impairment: A Randomized Controlled Pilot Trial - PROJECT SUMMARY This K76 proposal comprises a five-year research and career development plan to advance my, Dr. Hina Faisal’s, training in clinical research focused on aging and perioperative medicine, establish my independence as an investigator and prepare me for academic research leadership at the national and international level. I am an assistant professor at Houston Methodist Hospital with clinical expertise in anesthesia and critical care medicine and a research interest in delirium. Delirium is a sudden, fluctuating disturbance in consciousness and cognition and is highly prevalent in older surgical patients. With this award, I aim to develop the mastery needed in clinical aging research to develop, evaluate, implement, and distribute scalable nonpharmacological interventions capable of reducing the burden related to delirium. My long-term goal is to become a physician-scientist leader in geriatric-focused perioperative medicine. Delirium is preventable; nonpharmacological interventions, such as cognitive stimulation (CS), are the best preventive strategies . Implementing CS in acute hospital settings is a major challenge due to limited resources and low patient engagement. Virtual reality (VR) and gamification to deliver CS might be a scalable and engaging solution. Based on my preliminary work, I hypothesize that VR- based CS games will be safe, feasible, and acceptable in high-risk older patients (Aim 1). The proposed study will estimate the size of the effect of the intervention on cognitive functions, particularly sustained attention (Aim 2), and the incidence of postoperative delirium (Aim 3). To accomplish the above goals, I will conduct a randomized controlled pilot trial involving 90 patients ≥65 years old with pre-existing cognitive impairment admitted to the hospital following a major surgery. Patients will be randomized to 1:1:1 to receive VR-based CS games (intervention), watch a movie in VR (VR control), or receive standard-of-care nurse-led reality orientation (Nurse control). The trial will provide me with preliminary data to apply for an R01. To accomplish my research and career goals, my mentors and I have strategically designed a career development plan that integrates coursework, seminars, and mentorship in the following areas: (1) Incorporate geriatric medicine principles into perioperative medicine; (2) Gaining expertise in the design and conduct of clinical trials in older adults; (3) Training in neurocognitive testing and VR implementation; and (4) Enhancing leadership skills. I have assembled an outstanding group of interdisciplinary mentors and collaborators, including a leader in the assessment of health outcomes in aging (Dr. George Taffet), an international leader in technology implementation in older adults (Dr. Malaz Boustani), a clinical neuropsychologist (Dr. Kenneth Podell), and an expert in the application of VR technology (Dr. Junhyoung Kim). If successful, my research will open a new avenue of investigation in aging and delirium research, which aligns with the NIA’s strategic goal to develop effective interventions to reduce the burden of age-related disorders.
