As the global population ages and more elderly patients undergo surgery, healthcare providers are facing new challenges—among them, how to minimize postoperative cognitive decline. One promising strategy is preoperative cognitive training, a non-invasive, proactive approach designed to strengthen the brain’s resilience before anesthesia and surgery.
Surgical procedures, especially those requiring general anesthesia, can place significant stress on the brain. This is particularly concerning for older adults, who are at greater risk for perioperative neurocognitive disorders (PNDs), such as postoperative delirium and cognitive dysfunction. These conditions can impair memory, attention, and executive function—sometimes for months after surgery—affecting a patient’s ability to recover and maintain independence 1,2.
Cognitive training aims to “exercise” the brain before anesthesia and surgery, similar to how physical prehabilitation prepares the body. By strengthening mental processes like memory, processing speed, and attention, patients may be better equipped to handle the cognitive stress of surgery and anesthesia.
Cognitive training involves structured activities and exercises designed to target specific cognitive functions. These may include computer-based brain games that challenge memory, attention, and problem-solving skills; paper-based puzzles like crosswords and number games; guided mental exercises like visualizations or focus techniques; or dual-task activities that require patients to perform physical and mental tasks simultaneously.
Training is typically carried out in short daily sessions over several days or weeks leading up to surgery. Some programs are supervised by clinicians, while others can be completed at home using apps or printed materials 3,4.
Though still an emerging field, early studies suggest that cognitive training before anesthesia and surgery may offer real benefits. Research has shown that older adults who engaged in preoperative cognitive exercises had fewer postoperative cognitive issues compared to study participants in the control group. Data from different studies have also demonstrated that cognitive training may increase neuroplasticity (though other factors might be at play as well), an essential factor in recovery from surgical stress. In addition, cognitive training has been linked to better mood, reduced anxiety, and improved sleep—all of which contribute to a smoother recovery process. 5–8
Cognitive training is particularly beneficial for older adults, especially those over 65, patients with mild cognitive impairment, individuals undergoing major or high-risk surgery, such as cardiac or orthopedic procedures, and patients expressing concerns about memory or focus before surgery 9–11.
To be effective, cognitive training should ideally be introduced as part of a comprehensive preoperative program, which may also include physical prehabilitation, nutritional counseling, and medication review. Healthcare providers can recommend commercially available training programs or collaborate with neuropsychologists for tailored interventions 8,12–14.
Cognitive training before anesthesia and surgery is a forward-thinking strategy that holds promise in improving surgical outcomes, especially in vulnerable patient populations. As research grows, integrating cognitive fitness into preoperative planning may soon become a standard part of holistic perioperative patient care.
References
1. Kong, H., Xu, L. & Wang, D. Perioperative neurocognitive disorders: A narrative review focusing on diagnosis, prevention, and treatment. CNS Neurosci Ther 28, 1147–1167 (2022). DOI: 10.1111/cns.13873
2. Janjua, M. S., Spurling, B. C. & Arthur, M. E. Postoperative Delirium. in StatPearls (StatPearls Publishing, Treasure Island (FL), 2025).
3. Can Cognitive Training Really Lead to Lasting Mental Improvement? Verywell Mind https://www.verywellmind.com/cognitive-training-long-term-improvement-2795014.
4. Gobet, F. & Sala, G. Cognitive Training: A Field in Search of a Phenomenon. Perspect Psychol Sci 18, 125–141 (2023). DOI: 10.1177/17456916221091830
5. Ballesteros, S., Voelcker-Rehage, C. & Bherer, L. Editorial: Cognitive and Brain Plasticity Induced by Physical Exercise, Cognitive Training, Video Games, and Combined Interventions. Front. Hum. Neurosci. 12, (2018). DOI: 10.3389/fnhum.2018.00169
6. Park, D. C. & Bischof, G. N. The aging mind: neuroplasticity in response to cognitive training. Dialogues Clin Neurosci 15, 109–119 (2013). DOI: 10.31887/DCNS.2013.15.1/dpark
7. Tham, X. C. et al. Train-your-brain program to reduce depression, anxiety, and stress in stroke survivors: a pilot community-based cognitive intervention study. Front Neurol 14, 1163094 (2023). DOI: 10.3389/fneur.2023.1163094
8. Zhao, L., Guo, Y., Zhou, X., Mao, W. & Li, L. Preoperative cognitive training improves postoperative cognitive function: a meta-analysis and systematic review of randomized controlled trials. Front Neurol 14, 1293153 (2024). DOI: 10.3389/fneur.2023.1293153
9. Jiang, Y. et al. Cognitive training in surgical patients: a systematic review and meta-analysis. APS 1, 18 (2023). DOI: 10.1007/s44254-023-00014-6
10. He, Y. et al. Cognitive prehabilitation for older adults undergoing elective surgery: a systematic review and narrative synthesis. Front Aging Neurosci 16, 1474504 (2024). DOI: 10.3389/fnagi.2024.1474504
11. Ros-Nebot, B. et al. Cognitive Training to Reduce Memory Disturbance Associated With Postoperative Cognitive Impairment After Elective Noncardiac Surgery: An Experimental Study. Journal of PeriAnesthesia Nursing 39, 558–566 (2024). DOI: 10.1016/j.jopan.2023.10.016
12. Ishizawa, Y. Preoperative Cognitive Optimization and Postoperative Cognitive Outcomes: A Narrative Review. CIA 20, 395–402 (2025). DOI: 10.2147/CIA.S505388
13. Lau, K. T. et al. Preoperative cognitive training for the prevention of postoperative delirium and cognitive dysfunction: a systematic review and meta-analysis. Perioper Med (Lond) 13, 113 (2024). DOI: 10.1186/s13741-024-00471-y
14. Nebot, B. R. Implementation of a Cognitive Training Program in the Elderly to Reduce the Risk of Postoperative Cognitive Dysfunction in Elective Non-Cardiac Surgery; https://clinicaltrials.gov/study/NCT03620968 (2022).