Post-surgical delirium, a state of confusion and altered mental status, is a common and often distressing complication for older adults undergoing surgery. While frequently considered a temporary setback, emerging research suggests that for some patients, particularly those with pre-existing neurodegenerative conditions like Alzheimer’s disease, this delirium can have lasting and detrimental effects, accelerating cognitive decline. Now, a new approach utilizing vagus nerve stimulation (VNS) is showing promise in mitigating these effects and improving post-operative recovery.
The vagus nerve, often referred to as the “wandering nerve,” is the longest cranial nerve in the body. It extends from the brainstem to the abdomen, innervating a vast array of organs, including the heart, lungs, and gut. It plays a crucial role in regulating numerous bodily functions, including heart rate, digestion, and immune response. Increasingly, research highlights its significant influence on brain health and inflammation.
A recent study conducted by researchers at Duke University School of Medicine, published in , investigated the potential of stimulating this nerve to improve recovery outcomes in older patients. The study, led by anesthesiology professor Niccolò Terrando and biomedical engineering professor Warren Grill, focused on a technique called percutaneous vagus nerve stimulation, or pVNS.
“But for many patients, especially those with underlying neurodegeneration, (surgery) can permanently alter the trajectory of the disease,” Terrando explained. This observation underscores the critical need for interventions that can protect vulnerable patients from the long-term consequences of post-operative delirium.
The research team utilized a mouse model to explore the effects of pVNS following a surgical procedure. Their findings revealed that activating the vagus nerve reduced brain inflammation and disruptions in attention and awareness – key hallmarks of post-operative delirium. This suggests that stimulating the vagus nerve can help restore normal brain function and protect against cognitive decline.
pVNS involves using a small, minimally invasive device to deliver gentle electrical pulses through the skin to stimulate the vagus nerve. This approach, developed at Duke University, offers a potentially safe and effective way to modulate nerve activity without the need for invasive surgery. The technique is gaining traction as a potential therapeutic intervention for a range of neurological and psychiatric conditions, as highlighted in recent reviews of VNS advancements.
The implications of this research extend beyond simply treating the symptoms of delirium. The findings challenge the traditional view of post-operative delirium as a fleeting side effect, suggesting instead that it can represent a critical turning point in the progression of neurodegenerative diseases. By intervening early with pVNS, it may be possible to prevent or mitigate the long-term cognitive consequences of surgery in vulnerable patients.
Currently, We find no FDA-approved treatments specifically designed to prevent delirium after surgery. This lack of effective therapies underscores the urgency of finding new approaches to protect patients during this vulnerable period. The Duke University study offers a promising avenue for development, and clinical trials in human surgical patients are already underway.
The potential benefits of VNS are not limited to post-operative delirium. Research has also demonstrated its effectiveness in improving mobility after stroke, suggesting a broader role in neurological recovery. VNS works by influencing the brain’s ability to “rewire” itself, promoting plasticity and restoring lost function.
While the research is still in its early stages, the initial findings are encouraging. The ongoing clinical trials will be crucial in determining the safety and efficacy of pVNS in human patients. If successful, this innovative approach could revolutionize the way we care for older adults undergoing surgery, offering a new hope for preserving cognitive function and improving quality of life.
It’s important to note that VNS is not a standalone solution. Comprehensive post-operative care, including careful monitoring, pain management, and early mobilization, remains essential. However, pVNS represents a potentially valuable addition to the toolkit for protecting vulnerable patients from the devastating consequences of post-operative delirium.
