Preoperative Cognitive Optimization and Postoperative Cognitive Outcomes: A Narrative Review

Abstract

Background: Perioperative neurocognitive disorder (PND) is a growing concern and affects millions of older adult surgical patients each year in the United States. However, the effective prevention of PND has yet to be established. Recently, preoperative brain exercise has been suggested to decrease postoperative delirium incidence in older patients. This review aims to interpret existing preoperative cognitive optimization research, determine if the research supports preoperative cognitive optimization, and identify gaps in the knowledge of the older surgical population.

Methods: A literature search was performed in Pub Med (1995-2024) using the keywords (Older Surgical Patients, Presurgical Assessment, Cognitive Optimization, Neurocognitive Disorder, Postoperative Cognitive Impairment, Postoperative Delirium, Dementia, Frailty Syndrome, Prehabilitation, and Brain Plasticity). The type of literature included clinical trials, case series, cohort studies, and reviews. Among these articles, I included the one in which full text is available in Pub Med and is identified that specifically investigates cognitive function in older adults.

Results and conclusion: Evidence of the effect of preoperative cognitive optimization on postoperative cognitive functions in older adult surgical patients is still limited. Postoperative delirium was reduced by preoperative cognitive training. A limited number of clinical studies suggest the beneficial effect of preoperative cognitive training, but others show no effects. Further studies are needed on the cognitive training dosage, duration, and platform type. Studies are also required in presurgical patients with preexisting cognitive impairment or dementia.

Keywords: cognitive frailty; cognitive optimization; perioperative neurocognitive disorder; postoperative cognitive impairment; postoperative delirium.