Perioperative neurocognitive disorder (PND)
Conditions
Interventions
Sham Group:The operation process was exactly the same as that of the true rTMS group. Stimulation was carried out using false coils/side-placed coils. The coils had no effective magnetic field output
Active group:1. Preoperative: Target: Left DLPFC (International 10-20 system F3 site)
Intensity: 100% motor threshold (MT), defined as the minimum intensity for inducing MEP=50µV in the right abductor pollicis brevis muscle (5/10 successful attempts)
Frequency: 10Hz, 5-second stimulation string + 20-second interval
Single pulse count: 2000
Single duration: 20 minutes
2. Postoperative: Standardized intermittent theta burst stimulation iTBS protocol, target: left DLPFC (International 10-20 system F3 site)
The fixed 3-pulse/burst, 50Hz burst frequency, 5Hz burst repetition frequency, 80% resting motor threshold (which can be fine-tuned according to the patient's tolerance), 2-second continuous stimulati
Sponsors
Xuzhou Central Hospital
Eligibility
Sex/Gender
All
Age
50 Years to No maximum
Inclusion criteria
Inclusion criteria: 1. Age: 50 years old or above, gender not limited, primary school education or above; 2. Elective general anesthesia surgery (major abdominal surgery, orthopedic/spinal surgery, major thoracic surgery, etc.); 3. Preoperative mini-mental state examination (MMSE) score >= 24, with no clear diagnosis of dementia; 4. There are no contraindications for TMS, MRI or EEG examinations, and one can cooperate to complete relevant examinations, interventions and follow-ups. 5. The patient or their legal representative fully understands the research content and voluntarily signs a written informed consent form.
Exclusion criteria
Exclusion criteria: 1. There is a history of central nervous system diseases such as stroke, Parkinson's disease, epilepsy, Alzheimer's disease, and major depression; 2. There are contraindications for TMS/MRI examinations: intracranial metal implants, pacemakers, cochlear implants, skull defects greater than 3cm, or a history of epilepsy/family history; 3. Preoperative presence of severe organ failure (grade IV cardiac function, respiratory failure requiring mechanical ventilation, decompensated liver and kidney failure), sepsis, or end-stage malignant tumors; 4. There is a clear cognitive impairment or dementia before the operation, or due to visual, hearing or language impairments, it is impossible to cooperate with the cognitive scale assessment; 5. Long-term use of psychotropic drugs, sedative-hypnotic drugs, or a history of alcohol or drug dependence; 6. Pregnant or lactating women; 7. Those who are expected to be unable to complete follow-up after the operation or have poor compliance and are judged by the researchers as unsuitable for enrollment.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Incidence of postoperative PND; | — |
Secondary
| Measure | Time frame |
|---|---|
| Improvement of neuroimaging markers (lymphatic clearance function);Electroencephalogram indicators;Clinical outcome indicators;rTMS intervenes in related adverse events;Surgery-related indicators: Intraoperative anesthesia duration, actual operation duration, intraoperative blood loss, infusion volume, blood transfusion volume, average intraoperative blood pressure/heart rate, blood oxygen saturation, types and dosages of anesthetic drugs used.;Laboratory tests: Inflammation-related indicators: such as IL-6, TNF-a; | — |
Countries
China
Contacts
Public ContactZhou Meiyan
Xuzhou Central Hospital
Outcome results
None listed