Perioperative neurocognitive disorder is a complication that affects cognitive function in some patients after anesthesia and surgery. Understanding this disorder is essential for healthcare professionals involved in the care of surgical patients, particularly anesthesiologists, surgeons, and perioperative nurses.
Perioperative neurocognitive disorder is an umbrella term used to describe a spectrum of cognitive impairments associated with surgery and anesthesia. It includes several conditions, including postoperative delirium, an acute and often fluctuating disturbance in attention and awareness typically emerging within days after surgery; delayed neurocognitive recovery, or cognitive decline seen up to 30 days postoperatively; and postoperative neurocognitive disorder, characterized by persistent cognitive impairment that can last beyond 30 days and sometimes extend up to a year or more after surgery.
Patients may experience significant impact in cognitive domains such as attention, memory, executive function, and information processing. These impairments may diminish a patient’s quality of life, hinder their ability to live independently, and negatively influence their long-term mental health 1,2.
Older adults, particularly those over the age of 65, are at the highest risk for perioperative neurocognitive disorder. Additional risk factors include preexisting cognitive impairment (even if mild), frailty and poor functional status, multiple comorbidities such as cardiovascular disease or diabetes, the type and duration of surgery (especially cardiac or orthopedic procedures), intraoperative complications like hypotension or hypoxia, and inadequate pain control or the postoperative use of certain medications, such as benzodiazepines and anticholinergics 3–6.
Diagnosis involves formal cognitive testing, often using tools like the Montreal Cognitive Assessment (MoCA) or Mini-Mental State Examination (MMSE). Diagnosis requires comparing preoperative baseline scores with postoperative assessments. In practice, however, preoperative cognitive testing is not routinely performed, leading to underdiagnosis or misattribution of symptoms to aging or dementia, which may or may not be related 7–9.
Managing perioperative neurocognitive disorder involves a combination of preventive strategies and supportive care throughout the surgical journey. A thorough preoperative assessment, including screening for baseline cognitive function, helps identify patients at higher risk. Multidisciplinary optimization before surgery, such as managing comorbid conditions and reviewing medications, is key. Anesthetic techniques also play a critical role, as monitoring the depth of anesthesia and avoiding excessive sedation may help reduce risk. In some cases, regional anesthesia may also be advantageous.
Intraoperative care focuses on maintaining stable hemodynamics, proper oxygenation, and glucose control to reduce brain stress and minimize the risk of ischemia. Postoperatively, several interventions can support cognitive recovery and reduce the likelihood of delirium. These include early mobilization, promoting good sleep hygiene, managing pain effectively without causing oversedation, and involving family members in the patient’s recovery process. Alone or in combination with additional measures, these tips form a comprehensive approach to help reduce the incidence and severity of perioperative neurocognitive disorder 10–13.
Perioperative neurocognitive disorder is a significant and often underrecognized complication, especially in older surgical patients—early identification, thoughtful anesthetic and surgical planning, and comprehensive perioperative care can mitigate its effects.
References
1. Frontiers | Perioperative neurocognitive disorders. https://www.frontiersin.org/research-topics/58792/perioperative-neurocognitive-disorders.
2. 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
3. Guo, J., Cheng, Y. & Yi, M. Analysis of risk factors related to perioperative neurocognitive disorders in elderly patients with hip fractures. Sci Rep 15, 4816 (2025). DOI: 10.1038/s41598-025-89633-6
4. Li, Y.-L., Huang, H.-F. & Le, Y. Risk factors and predictive value of perioperative neurocognitive disorders in elderly patients with gastrointestinal tumors. BMC Anesthesiol 21, 193 (2021). DOI: 10.1186/s12871-021-01405-7
5. Perioperative neurocognitive disorders in adults: Risk factors and mitigation strategies – UpToDate. https://www.uptodate.com/contents/perioperative-neurocognitive-disorders-in-adults-risk-factors-and-mitigation-strategies/print.
6. Evered, L., Atkins, K., Silbert, B. & Scott, D. A. Acute peri-operative neurocognitive disorders: a narrative review. Anaesthesia 77, 34–42 (2022). DOI: 10.1111/anae.15613
7. mocacognition.com/. https://mocacognition.com/.
8. Mini-Mental State Examination (MMSE) – scoring, results and uses | healthdirect. https://www.healthdirect.gov.au/mini-mental-state-examination-mmse.
9. Silverstein, J. H. & Deiner, S. G. Perioperative delirium and its relationship to dementia. Prog Neuropsychopharmacol Biol Psychiatry 43, 108–115 (2013). DOI: 10.1016/j.pnpbp.2012.11.005
10. Safavynia, S. A., Goldstein, P. A. & Evered, L. A. Mitigation of perioperative neurocognitive disorders: A holistic approach. Front Aging Neurosci 14, 949148 (2022). DOI: 10.3389/fnagi.2022.949148
11. Yürek, F. et al. Perioperative Neurocognitive Disorders – Postoperative Prevention Strategies. Anasthesiol Intensivmed Notfallmed Schmerzther 54, 669–683 (2019). DOI: 10.1055/a-0853-3116
12. Rengel, K. F., Boncyk, C. S., DiNizo, D. & Hughes, C. G. Perioperative Neurocognitive Disorders in Adults Requiring Cardiac Surgery: Screening, Prevention, and Management. Semin Cardiothorac Vasc Anesth 27, 25–41 (2023). DOI: 10.1177/10892532221127812
13. Peden, C. J. et al. Improving perioperative brain health: an expert consensus review of key actions for the perioperative care team. British Journal of Anaesthesia 126, 423–432 (2021). DOI: 10.1016/j.bja.2020.10.037