EEG-TMS Intervening Against Postoperative Delirium

Postoperative delirium(POD), a syndrome characterized by an acute change in attention, awareness and cognition, is one of the most common postoperative complications among elderly patients. Impaired neuronal network connectivity is likely one of the several neurobiological processes that contribute to POD pathogenesis. Recently, continuous theta burst stimulation (cTBS), a pattern of TMS, was demonstrated to improve cognitive function in patients with mild cognitive impairment.Recent research suggests that cTBS has positive effect on improving the connectivity and reorganization of the brain network.This project team conducted a pilot study in the early stage and innovatively applied cTBS to treat postoperative delirium in elderly patients. The results preliminarily elucidate the safety, and feasibility of TMS in treating postoperative delirium in elderly patients.

In order to confirm the effectiveness of EEG-TMS therapy for POD and observe its impact on long-term prognosis, this project will conduct a prospective randomized controlled study to compare TMS therapy with sham stimulation therapy. The study will observe The duration of postoperative delirium during the 7-day intervention period, as well as severity of delirium, the time to successful discharge (defined as the patient surviving outside the hospital for at least 48 hours after discharge), and the 30-day and 90-day survival times, the number of patients receiving salvage drug treatment, and the number of days each patient received salvage drug treatment, the sensitivity, specificity, and predictive value of EEG. The trial will provide new ideas for the prediction and treatment of postoperative delirium in clinic.

Inclusion criteria

• Age ≥60 years;
• Scheduled for non-cardiac surgery;
• Positive assessment for delirium via the CAM-ICU or 3D-CAM after surgery.

Exclusion criteria

• Chronic use of antipsychotic medications;
• Receipt of antipsychotic drugs prior to enrollment;
• Permanently incapacitated patients (lacking decision-making capacity);
• Inability to undergo delirium assessment (e.g., due to language barriers, deafness, blindness, aphasia, or coma);
• Treatment withdrawal or brain death;
• Known pregnancy or lactation;
• Inability to obtain informed consent per national regulations;
• Patients under compulsory hospitalization (involuntary commitment) by regulatory authorities;
• Alcohol withdrawal delirium (delirium tremens);
• Contraindications to transcranial magnetic stimulation (TMS);
• Acute infectious diseases.