Preoperative cognitive training for preventing perioperative neurocognitive disorders: A systematic review and meta-analysis with trial sequential analysis and meta-regression of randomised controlled trials.

Authors

Yi Gao, Huaijing Hou, Kang Yu, Zhiwen Yang, Ruiyu Yang, Leyao Du, Xiuxia Li, Huihui Miao, Jianjun Xue, Tianzuo Li

Published in

Journal of clinical anesthesia. Volume 116. Pages 112359. Oct 25, 2026. Epub Oct 25, 2026.

Abstract

Although nonpharmacological interventions are recommended for preventing perioperative neurocognitive disorders (PND), cognitive training has not been explicitly advocated. Therefore, this systematic review and meta-analysis with trial sequential analysis (TSA) and meta-regression tested the hypothesis that preoperative cognitive training, compared with usual care, reduces the incidence of PND.
Eight databases and two clinical trial registries were searched for RCTs comparing preoperative cognitive training with usual care. Primary outcomes were postoperative delirium (POD), delayed neurocognitive recovery (DNR), and postoperative neurocognitive disorder.
Thirteen RCTs with 1446 patients were identified. Preoperative cognitive training was associated with a lower risk of POD (RR 0.53; 95% CI 0.36-0.77; P = 0.001; low certainty). Subgroup analysis (P for interaction = 0.01) and meta-regression (β1 1.072, 95% CI 0.006-2.138, P = 0.049) suggested an association between training format and treatment effect on POD, with a potentially greater benefit for traditional training. For DNR, the incidence was lower in the training group than in the usual care group (RR 0.66; 95% CI 0.46-0.96; P = 0.03; very low certainty), but this finding was not supported by several sensitivity analyses. No significant differences were detected between subgroups for training format, total duration, or surgery type (P for interaction = 0.06, 0.37, and 0.34, respectively), and meta-regression suggested that overall risk of bias was a potential moderator for DNR (P = 0.045). TSA suggested a potential for false-positive findings, as the cumulative Z-curves did not cross the TSA boundaries, and the required information sizes were not reached for either outcome.
Preoperative cognitive training may reduce the incidence of POD, with traditional training showing a potentially greater benefit than digital training. For DNR, the current evidence is insufficient to support a preventive effect of preoperative cognitive training, although a trend toward benefit was observed. These findings are limited by high risk of bias in several included trials and failure to reach the required information sizes in TSA, particularly for DNR, which need to be confirmed in future large-scale RCTs.
PROSPERO (CRD420261293607).

PMID:
42927691
Bibliographic data and abstract were imported from PubMed on 26 Oct 2026.

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