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Preoperative cognitive training for preventing perioperative neurocognitive disorders: A systematic review and
Yi Gao1, Huaijing Hou2, Kang Yu1
1Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
Study Objective:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
Systematic Review Protocol:
PROSPERO (CRD420261293607).