Objectives <p>The aim of this systematic review and meta-analysis is to synthesize and appraise the evidence on prevalence of cognitive impairment following acute respiratory distress syndrome (ARDS) of any cause.</p> Methods <p>We systematically searched PubMed, Scopus, and Web of Science for observational studies focused on cognitive impairment in adult survivors of ARDS. Risk of bias and certainty of evidence (GRADE) were assessed. A meta-analysis using a random effects model was performed to estimate the overall prevalence of cognitive impairment after ARDS, with subgroup analyses for COVID-19-related ARDS (C-ARDS). Additionally, a meta-regression was conducted to assess the influence of demographic and clinical predictors on cognitive outcomes. Heterogeneity was assessed using τ² and the I² statistic.</p> Results <p>We identified 14 studies with 1451 participants, with 650 participants (range: 13–98) included in the analyses. In the subgroup of C-ARDS, 12 studies with 563 participants (range: 13–98) were considered.&#xa0;The pooled prevalence of cognitive impairment following ARDS was 36% (95% CI 26–46%), with high heterogeneity between studies (I² = 92%, τ² = 0.03). In C-ARDS cohorts, the prevalence was 34% (95% CI 22–45%), with similar levels of heterogeneity (I² = 92.7%, τ² = 0.03). Meta-regression analysis showed &#xa0;that older age predicted a higher prevalence of cognitive impairment following ARDS (b = 0.02, p = 0.033), reducing between-study heterogeneity (I² = 60.04%, τ² = 0.01). ICU stay, sex, and time from ICU discharge to cognitive assessment showed no significant associations (p &gt; 0.05).</p> Conclusions <p>This meta-analysis corroborates previous findings that cognitive impairment remains a persistent issue for ARDS survivors. The prevalence of cognitive impairments following ARDS highlights the importance of future research to unravel the complex underlying mechanisms contributing to these deficits and to develop targeted strategies for prevention and rehabilitation in survivors.</p>