top of page

Postoperative Neurocognitive Disorder


  • Formerly known as Post-operative Cognitive Dysfunction (POCD)

  • Subtle cognitive impairment that differs from overt delirium

  • Consists of two syndromes:

    1. Delayed neurocognitive recovery

      • patient is back to baseline by 30 days

    2. Post-op neurocognitive disorder

      • cognitive decline which persists up to 12 months post-op

      • Mild = mild cognitive impairment (MCI) equivalent

      • Major = dementia equivalent

  • Pathophysiology 

    • Thought to be secondary to inflammatory response of surgery


  • Risk factors:

    • Age > 65, pre-operative cognitive impairment, critically ill, excessive EtOH use, polypharmacy, frailty, hx of stroke or TIA, other comorbid dz (DM, vascular dz), lower education level

    • Major ortho sx, cardiac sx, otherwise long sx

  • Useful to perform baseline cognitive screen (i.e. MMSSE or Mini-Cog) in suspected pts

  • Consider use of BIS or raw EEG monitor to avoid burst suppression

  • Employ cerebral oximetry to avoid drop in rSO2

  • No difference in incidence based on anesthetic technique (GA vs regional or inhalation vs IV)


  • Identify high-risk patients

  • If high-risk:

    • Avoid excessive anesthetic depth (i.e. burst suppression)

    • Avoid prolonged periods of hypotension

    • Avoid ↓ cerebral oximetry

    • Avoid benzos & gabapentinoids

    • Minimize opioids

  • Multi-modal analgesia for opioid-sparing effect

    • e.g. Acetominophen +/- NSAIDs +/- steroids +/- ketamine +/- dexmedetomidine infusion

  • Employ routine measures to avoid post-operative delirium (e.g. early mobilization, removing drains/restraints/lines etc.)

    • See post-operative Delirium​​​


  • ​Olotu, Cynthia. Postoperative neurocognitive disorders. Current Opinion in Anaesthesiology 33(1):p 101-108, February 2020. DOI: 10.1097/ACO.0000000000000812 

bottom of page