Surgeons must navigate the complex landscape of surgical decision-making for patients with dementia, emphasizing informed choices and collaboration.

• 28 recommendations were developed, with 25 deemed critically important but feasible only in the long-term.
• Consensus among 23 stakeholders highlighted the need for better resources and team-based care for surgical candidates with cognitive impairment.

Prioritize education on dementia in surgical practice to enhance outcomes and effectively support patients and families.

• All 21 research priorities gained high consensus, guiding future studies crucial for improving surgical strategies.