Cognition in adults with cerebral palsy: A systematic review

AIM: To synthesize evidence on cognitive functioning in adults with cerebral palsy (CP), evaluate the feasibility and validity of cognitive screens, determine whether cognitive functioning declines with age, identify factors associated with cognitive outcomes, and summarize interventions reporting cognitive outcomes. METHOD: Five databases were searched through 2025. Eligible studies enrolled adults with CP and reported cognitive outcomes. Two reviewers screened and extracted data; quality was appraised with JBI tools and certainty graded using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Findings were synthesized narratively according to cognitive domain. RESULTS: Thirty studies (estimated 1150 adults, 3900 assessments) were included. Executive function, and visuospatial and perceptual-motor skills, were most frequently impaired. Attention and processing speed and episodic memory were also commonly reduced. Certainty was moderate for executive function and very low for other domains because of small samples, bias, inconsistency, and imprecision. Longitudinal and registry data suggested stability from late adolescence through mid-adulthood. Greater motor severity and reduced manual ability were associated with lower cognitive performance. No motor-minimized, CP-validated screening battery was identified across 48 instruments. INTERPRETATION: Adults with CP commonly show domain-specific cognitive difficulties that are established early and remain stable through mid-adulthood. Measurement limitations and selection biases constrain prevalence estimates. Priorities include motor-minimized tools with CP-specific norms, adequately powered trials with standardized cognitive endpoints, and longitudinal cohorts examining modifiable factors.