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Direct-to-Patient (DPEP) Education Program

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 carers 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.

Learn more about the Direct-to-Patient Education Program »

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.

What is delirium?

  • 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).

What are the signs and symptoms of delirium?

  • 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.


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.

Before surgery

Pair of glasses. 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.
Smartphone. Make sure you have your phone. This will help you stay connected with family and friends, which is important for brain health.
Crossword puzzle and pencil. Keeping your brain active before surgery by doing crossword puzzles, word searches, etc. can help to reduce the risk of delirium.
Alarm clock. Getting seven or more hours of sleep can help with alertness and memory.
Healthy food. Eat a healthy and balanced diet.
Glass of water. Stay hydrated – you can drink clear fluids up to 2 hours before surgery.

In hospital

Hand holding. Have a family member visit with you.
Person on the phone. 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.
Person walking. Keep your body active.
Person sleeping. Remember to rest and sleep.
Person speaking to nurse. Tell your health-care team about any changes in symptoms.

Read more about delirium prevention »

Recovering from delirium: leaving the hospital

A person smiling. 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.
Question mark. If you have any questions or concerns about your health after leaving the hospital, reach out to your healthcare team or your family doctor.

Learn what you and your family can do to help you recover from delirium »