The Direct-to-Patient Education Program (DPEP) is aimed at helping patients reduce their risk of developing problems with thinking and memory that can occur after anesthesia and surgery.
This site provides patients, family, friends, and careers with resources to help empower patients to make informed decisions about their perioperative (around the time of surgery) brain health, including strategies before surgery, during time in hospital, and while in recovery.
Changes to Thinking and Memory
Perioperative neurocognitive disorders describe a spectrum of changes to thinking and memory that can occur after anesthesia and surgery. Patients may experience difficulties with short-term memory and concentration. The causes are not fully understood, but likely related to stress and inflammation that result from surgery and anesthesia.
Delirium and post-operative neurocognitive disorder (P-NCD) are common cognitive complications that are associated with increased risks of a longer hospital stay, being re-admitted to hospital, or mortality. The disorders can be missed or misdiagnosed as they may be masked or not as evident until after surgery. Patients have been shown to demonstrate symptoms of delirium for days or weeks after their procedure, while symptoms of P-NCD can last for months or years.
Delirium and P-NCD can affect anyone. Elderly patients, particularly those undergoing cardiac surgery, are at highest risk for P-NCD.
- Delirium is a state of mental confusion that develops quickly after surgery.
- Is a common condition among older individuals undergoing surgery but can happen to anyone after surgery.
- Individuals with pre-existing cognitive concerns are at a higher risk of developing delirium.
- Delirium is caused by organ dysfunction. The risk of delirium increases in those with multiple medical conditions (e.g. heart, lung, and kidney failure).
- Changes in memory or language.
- Reduced ability to focus, sustain, or shift attention.
- Seeing or hearing things that are not there.
- Acting differently.
- The level of confusion can improve or worsen during the day.
- Delirium is usually temporary but may last for hours to weeks.
Treatment
There are no known pharmacological approaches to treat or prevent postoperative neurocognitive disorders. Therefore, the best way to manage delirium is to take preventative action before a patient’s surgery, while they are in hospital recovering, and after they leave hospital.
Clinical Research
Our research program aims to improve the prediction and prevention of cognitive complications following surgery. Research is also a critical to developing improved diagnostics and treatment in the brain and mental health. DPEP works with other departments in the hospital on collaborative projects and in mentoring trainees to foster next-generation research and innovation.
Learn more about how to participate in clinical trials that can identify or help treat patients who are at-risk for delirium and cognitive decline after surgery.
Delirium Prevention: Before and After Surgery
There are simple steps that patients and families can take that can help prevent delirium. Below are some tips to help patients for before and after surgery.
Make sure you have your glasses and hearing aids. Being able to see and hear properly will help to keep you oriented to what is going on around you and to help prevent confusion.
Make sure you have your phone. This will help you stay connected with family and friends, which is important for brain health.
Keeping your brain active before surgery by doing crossword puzzles, word searches, etc. can help to reduce the risk of delirium.
Getting seven or more hours of sleep can help with alertness and memory.
Eat a healthy and balanced diet.
Stay hydrated – you can drink clear fluids up to 2 hours before surgery.
Have a family member visit with you.
If visiting in-person is not possible, speak on the phone everyday. Continue this connection even after the patient has left the hospital to help keep the mind active.
Keep your body active.
Remember to rest and sleep.
Tell your health-care team about any changes in symptoms.
Continue the above health habits started before your surgery (for example, keeping your mind and body active, healthy diet, good rest and sleep, and staying connected to family and friends.
If you have any questions or concerns about your health after leaving the hospital, reach out to your healthcare team or your family doctor.
About Us
The Direct-to-Patient Education Program (DPEP) is a comprehensive and accessible educational program established in the department of anesthesia in 2022 by Dr. Stephen Choi.
The goal of DPEP is to educate patients, families, patient partners, and health-care professionals on the latest information for perioperative cognitive concerns to help protect brain health.
Our interdisciplinary team is dedicated to enhancing the care of patients before and after surgery. This includes personalizing of care for at-risk or affected individuals using evidence-based and non-pharmacological prevention strategies to support healthier aging in older adults undergoing surgery.
An important aspect of DPEP includes the development of novel and innovative strategies to help reduce cognitive decline and enhance health literacy.
Our Team
Collaborators
- Department of Anesthesia
- Cogstate
- Perioperative Brain Health Centre
- Sunnybrook Health Sciences Centre
- Senior Friendly
- GEMINI
Clinical Research
Clinical trials are essential to advancing healthcare by developing new therapies and approaches to patient care and treatments. Participants in clinical trials are critical to the success of our research. They kindly volunteer their time to help us discover novel and preventative treatments and approaches that may help improve the future of healthcare.
Learn about our clinical studies and how to participate, below.
About the study
Patients may be eligible for a clinical trial that investigats cognitive screening before surgery to identify those who may be at risk for delirium and decline in thinking and memory after surgery and promotes effective non-pharmacological intervention strategies to patients, caregivers, and healthcare providers.
This project aims to prevent both the incidence and severity of postoperative delirium, a serious neurological complication common in older surgical patients, by optimizing preoperative assessment procedures with the potential to prevent delirium.
What is involved
One to two weeks before surgery, participants will be asked to complete a short test measuring thinking and memory, and answer two questionnaires over the phone. Patients at a high-risk of delirium will be directed to the Direct-to-Patient Education program (DPEP) which provides educational materials about delirium prevention for patients, family members and caregivers. The patient’s high-risk for delirium will also be noted with doctors and nurses attending surgery. For the first three days after surgery, patients will fill out a short questionnaire to help test for delirium and the impact of prevention and education strategies.
Eligibility
- Patients who are 60 years and older.
- Undergoing major elective surgery with a planned postoperative stay of at least one night.
- Not undergoing a heart or brain surgery
How to participate
If you are interested in participating or would like more information, please contact the anesthesia research team at 416-480-6100 ext. 689607 or by email at anesthesia.research@sw.ca.
About the study
Patients may be eligible for a clinical trial testing a drug to reduce the incidence of persistent cognitive dysfunction after open cardiac surgery.
The CODEX study aims to investigate and potentially identify a treatment for postoperative cognitive dysfunction (POCD) which continues after a patient leaves the hospital and anticipated surgical recovery. The use of dexmedetomidine could lead to improved patient care, shorter hospital stay, and reduced costs at cardiac centres across Canada.
What is postoperative cognitive decline (POCD)?
POCD is characterized by reduced cognitive function (memory and executive function) after surgery. The highest risk of cognitive decline is linked to cardiac surgery.
What is dexmedetomidine?
Dexmedetomidine (DEX) is an approved sedative used in the Operating Room or Intensive Care Unit. It reduces delirium in the postoperative intensive care setting.
What is involved?
Participants are randomly assigned (a 50:50 chance) to receive dexmedetomidine as one of their medications in the ICU up to 24 hours after surgery, or to receive the conventional standard medications. Dexemedtomidine is approved by Health Canada to be used as a sedative in the intensive care unit and we are using this drug within its approved guidelines. DEX is known to decrease the chances of developing delirium.
Our study is investigating whether dexmedetomidine can help prevent POCD. Since we know that this sedative helps prevent delirium, that may help prevent cognitive dysfunction after surgery. Participants will also be asked to complete cognitive tests before and after surgery, both in the hospital and after going home, with follow-up occurring three, six, and 12 months after surgery.
Eligibility
- Patients who are 60 years and older.
- Scheduled for heart surgery including valve replacement and/or coronary bypass
How to participate
If you are interested in participating or would like more information, please contact the anesthesia research team at 416-480-6100 ext. 689607 or by email at anesthesia.research@sw.ca.
Patient Education and Engagement
Visit the DPEP program, our comprehensive online resource for patient education and empowerment.
Contact
Direct-to-Patient Education Program (DPEP)
Department of anesthesia
Email: brainhealth@sunnybrook.ca or anesthesia.research@sw.ca
Phone: 416-680-6100 ext 689607
Mailing address:
2075 Bayview Ave, Room M3-200
Toronto, Ontario
M4N 3M5
For questions about research or participating in clinical trials contact Lilia Kaustov: lilia.kaustov@sunnybrook.ca.
For questions about medical information with regard to participating in clinical trials contact Dr. Stephen Choi: brainhealth@sunnybrook.ca.