Older Patients' Postoperative Neurocognitive Recovery: A Narrative Review

Perioperative neurocognitive disorders, including postoperative delirium, delayed neurocognitive recovery and mild/major postoperative neurocognitive disorder, are common complications that affect older adults after surgery. Postoperative delirium, which occurs in 10-60% of major surgery patients, can increase the risk of delayed neurocognitive recovery and postoperative neurocognitive disorder, which affects 10-25% of patients. Preoperative and postoperative assessment of neurocognitive functioning typically involve the use of screening tools, such as Mini-Cog or 4AT. Despite the availability of evidence-based cognitive screening tools, many patients remain undiagnosed in clinical settings. Both postoperative delirium and postoperative neurocognitive disorder can lead to long-term cognitive and emotional complications, such as forgetfulness, trouble with initiating tasks, and mood disturbances. Next of kin experience considerable distress when witnessing delirium in a family member, a situation that is frequently exacerbated by a lack of information from health care professionals. Ethical challenges arise when cognitive impairment impacts patients' decision-making capacity, raising concerns about autonomy, use of restraints, and resource allocation. Informing patients about their risk of postoperative neurocognitive disorder before surgery is vital; however, it is not standardized in clinical practice. Further, there is a notable lack of interventions aimed at promoting neurocognitive recovery, with most guidelines relying on expert consensus. This narrative review therefore aims to explore recent advances in perioperative neurocognitive recovery, focusing on symptomatology, patient and next of kin experiences, assessments, care interventions and ethical aspects.