Cognitive prehabilitation in surgical patients: a scoping review.

Abstract

Cognitive prehabilitation aims to increase preoperative cognitive reserve to improve neurocognitive outcomes. Structured synthesis is required to describe the design, feasibility, adherence and outcomes of cognitive prehabilitation trials to inform current practice and future research. We conducted a scoping review using best practices. A protocol was registered, and a peer-reviewed search strategy was applied to MEDLINE, Embase, CINAHL, PsycINFO, Web of Science and Cochrane CENTRAL (inception to 04/2025). Duplicate, independent review identified studies that enrolled adults in randomised controlled trials of cognitive prehabilitation. Narrative synthesis described: 1) populations; 2) interventions; 3) adherence; 4) barriers; and 5) outcomes. Across eight included trials (n=833), mean age ranged from 56 to 73.2 yr; seven trials excluded participants with pre-existing cognitive impairment. Six trials evaluated home-based, computerised multidomain brain training; two involved supervised in-hospital sessions. Programme duration was 1-4 weeks; sessions lasted 15-60 min. Five trials reported low adherence (8.8%-40%); one achieved 68% adherence with supervision, whereas one in-hospital program achieved 94.1% adherence. Barriers included feeling overwhelmed, lacking technical support and time. Two trials with high adherence reported a significant reduction in delirium (Absolute Risk Reduction [ARR] 9.8%-15.9%) and postoperative neurocognitive disorders (ARR 20.2%-36.8%). Cognitive prehabilitation trials consistently evaluate multidomain, computerised brain training, and, with high adherence, efficacy is evident. Optimal duration and intensity must be established, and barriers related to support, time, and technology need be addressed before conducting evaluations in multicentre trials.