Non-Pharmacological Interventions for Cognitive Impairment After Intensive Care: A Scoping Review.

BACKGROUND

Cognitive impairment, a key component of post-intensive care syndrome, is one of the most common complications experienced by survivors discharged from the Intensive Care Unit. Cognitive impairment has become a global public health problem, which imposes a heavy burden on families and society. It is urgent to take measures to curb its occurrence and development. And non-pharmacological interventions for cognitive impairment have a positive effect on it. Therefore, a scoping review exploring the application of non-pharmacological interventions in cognitive impairment after intensive care may contribute to the development of the field of intensive care unit cognitive impairment intervention and provide a theoretical basis for related research.

AIM: To explore the types, subjects, duration, frequency and cognitive function assessment tools of non-pharmacological interventions for cognitive impairment after intensive care.

STUDY

DESIGN

An electronic search was conducted in PubMed (MEDLINE), CINAHL (EBSCO), Web of Science, SinoMed, Scopus, Embase, the Cochrane Library, Wanfang Database and China National Knowledge Infrastructure (CNKI) from database inception to April 2025. The included studies discussed the types, study subjects, duration, frequency and assessment tools of non-pharmacological interventions for cognitive impairment after intensive care.

RESULTS

This scoping review retrieved a total of 4825 relevant studies from 9 databases. According to the inclusion and exclusion criteria, a total of 24 studies were included in the review. The interventions were categorised into seven distinct yet often overlapping themes targeting cognitive impairment after intensive care: comprehensive care, exercise, cognitive training, virtual reality, environmental change, music therapy and ICU outpatient care. The intervention duration ranged from 5 days to 12 months, with frequencies varying from once daily to four times per week. Outcomes were measured using a battery of neurocognitive assessments.

CONCLUSION

Non-pharmacological intervention strategies for cognitive impairment after intensive care are diverse but highly heterogeneous, with a wide target population coverage and a lack of standardised assessment tools. Current research in this area has several limitations, including unclear conceptual frameworks, weak evidence and limited outcome evaluation, with many studies primarily focusing on preventive interventions. In future research, remote project-based scales can be used to simplify assessments, while further improving non-pharmacological interventions for cognitive impairment after intensive care, not only limited to prevention, but also focusing on symptomatic interventions for cognitive impairment after intensive care, providing patients with lifelong care services.

RELEVANCE TO CLINICAL PRACTICE: The significant burden of cognitive impairment after intensive care mandates its integration into standard post-ICU clinical pathways. This requires clinicians to: (1) implement systematic screening for cognitive deficits during follow-up using brief, validated tools, (2) adopt and tailor evidence-based non-pharmacological interventions, such as cognitive rehabilitation, psychoeducation and graded physical activity, as foundational components of care, and (3) foster interdisciplinary collaboration among ICU, primary care and rehabilitation teams to ensure seamless continuity. These coordinated steps are vital to alleviate the condition's impact on patient quality of life and curtail associated healthcare costs, particularly preventable readmissions.