Effect of Continuous Theta-Burst Stimulation on Postoperative Delirium in Older Patients Who Undergo Cardiac Surgery

Postoperative delirium (POD) is a common complication after cardiac surgery in older patients, associated with higher mortality and prolonged stays. Continuous theta-burst stimulation (cTBS), a noninvasive neuromodulation technique, has been shown to modulate cortical excitability, offering potential as a treatment for cognitive dysfunction after surgery. The posterior cingulate cortex (PCC) is strongly involved in resource allocation, episodic memory, and executive function. This study aims to investigate the efficacy of cTBS on PCC in reducing POD in older patients having cardiac surgery.

A single-center, randomized, double-blind, placebo-controlled trial was conducted. Older patients receiving cardiac surgery were randomly assigned to either active or sham cTBS groups. cTBS was applied to PCC for five days before and after surgery. The primary outcome was POD incidence during the first five postoperative days. Intention-to-treat analysis was performed in February 2026.

A total of 78 patients were recruited and randomly assigned to the active cTBS group (39 patients) or the sham cTBS group (39 patients). The active cTBS group showed a significantly lower incidence of POD than did the sham cTBS group (23.1% vs 48.7%). Moreover, the active cTBS group exhibited considerably lower levels of anxiety and pain, and reduced analgesic consumption. However, although the levels of tumor necrosis factor-α and interleukin-6 in the active cTBS group showed a downward trend, the changes did not reach statistical significance.

PCC-targeted cTBS effectively reduces POD in older patients who undergo cardiac surgery, alleviating anxiety, pain, and sleep disturbances. These findings suggest cTBS as a promising nonpharmacologic treatment for POD.

The Clinicaltrials.gov registration number for the study is NCT0557 5583.