Success analysis of virtual reality-­based cognitive training in patients after coronary artery bypass grafting

Aim. To analyze the success of virtual reality-­based multitask cognitive training (VR-MCT) in patients who underwent on-pump coronary artery bypass grafting (CABG), based on an assessment of neuropsychological and neurochemical parameters.

Material and methods. This prospective study included 49 male patients aged 45 to 75 years who underwent on-pump CABG and had early postoperative cognitive dysfunction (POCD). Beginning 3-4 days after CABG, patients underwent daily VR-MCT (mean session count — 6,7). In addition to the standard perioperative examination, all patients underwent psychometric testing and determination of neurovascular unit (NVU) markers — neuron-­specific enolase (NSE), S100β protein, and brain-­derived neurotrophic factor (BDNF).

Results. The success rate of VR-MCT course was 43%; 21 of 49 patients did not show POCD according to the established criteria at 11-12 days after CABG. Patients with successful VR-MCT showed improvements in attention (p=0,034) and short-term memory (p=0,016) compared with patients with unsuccessful training in the early postoperative period. In patients with successful VR-MCT, peripheral blood BDNF levels before surgery (p=0,029) and 1-2 days after CABG (p=0,04) were significantly higher compared to patients with unsuccessful training. We established factors specifying the complex indicator of the neurodynamics domain in VR-MCT — educational level, intima-­media thickness, patient age, number of trainings and S100β protein level on day 1 after surgery (R²=0,38, F (5,43)=8,32, p<0,001); the attention domain — patient age, educational level, initial BDNF concentrations, both at the first day and on the first day. Peripheral blood S100β protein concentration and Montreal Cognitive Assessment (MoCA) scores were assessed (R²=0,52, F (6,42)=10,76, p<0,001); for the short-term memory domain, the patient's age and baseline BDNF, NSE, and glucose concentrations were assessed (R²=0,37, F (4,45)=10,15, p<0,001).

Conclusion. The study results demonstrated that VR-MCT optimizes attention and short-term memory performance in patients with early POCD after on-pump CABG. Negative factors specifying cognitive status after VR-MCT include patient age, low education level, and ba­seline cognitive function, while protective factors include high pe­ri­operative BDNF concentrations and low peripheral blood con­cen­tra­tions of brain damage markers.

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