Perioperative neurocognitive disorders in elderly orthopedic surgery: from mechanistic insights to risk prediction and multimodal integrated care
- 1Guangzhou Red Cross Hospital
Abstract
Background: Perioperative neurocognitive disorders (PND) encompass pre-existing neurocognitive disorder, postoperative delirium (POD), delayed neurocognitive recovery, and postoperative neurocognitive disorder. Older orthopedic patients are vulnerable, but diagnostic and population heterogeneity complicate interpretation.
Methods: This narrative review critically synthesizes epidemiological, mechanistic, prediction, and intervention evidence, distinguishing formal diagnoses from screening-score changes and orthopedic-specific from transferable perioperative studies.
Findings: Multicomponent delirium prevention and coordinated perioperative assessment and recovery support provide the strongest clinical foundation. REGAIN, ENGAGES, the multicenter ketamine trial, and the minocycline trial were neutral for their relevant delirium or cognitive prevention outcomes. Signals from smaller studies of dexmedetomidine, peripheral nerve blocks such as the pericapsular nerve group (PENG) block, intranasal insulin, transcutaneous electrical acupoint stimulation (TEAS), repetitive transcranial magnetic stimulation (rTMS), and specific probiotic formulations require replication and safety assessment. Observational hemodynamic and biomarker findings do not establish preventive efficacy.
Conclusion: Care should combine guideline-supported delirium prevention with individualized supportive measures. Research priorities include standardized neurocognitive diagnosis, externally validated prediction models, and multicenter orthopedic trials that measure cognition, function, and harms.
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BibTeX
@article{ma2026perioperative,
title = {{Perioperative neurocognitive disorders in elderly orthopedic surgery: from mechanistic insights to risk prediction and multimodal integrated care}},
author = {Xiaoyu Ma and Lixian Zhang and Aiqun Wang and Weilong Peng and Hebin Qi and Yuhan Xiong and Shaoding Chen},
journal = {Frontiers in Neurology},
year = {2026},
month = nov,
doi = {10.3389/fneur.2026.1979460},
url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1979460/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Perioperative neurocognitive disorders in elderly orthopedic surgery: from mechanistic insights to risk prediction and multimodal integrated care
AU - Xiaoyu Ma
AU - Lixian Zhang
AU - Aiqun Wang
AU - Weilong Peng
AU - Hebin Qi
AU - Yuhan Xiong
AU - Shaoding Chen
PY - 2026
DA - 2026/11/10
JO - Frontiers in Neurology
DO - 10.3389/fneur.2026.1979460
UR - https://www.frontiersin.org/articles/10.3389/fneur.2026.1979460/full
AB - Background: Perioperative neurocognitive disorders (PND) encompass pre-existing neurocognitive disorder, postoperative delirium (POD), delayed neurocognitive recovery, and postoperative neurocognitive disorder. Older orthopedic patients are vulnerable, but diagnostic and population heterogeneity complicate interpretation. Methods: This narrative review critically synthesizes epidemiological, mechanistic, prediction, and intervention evidence, distinguishing formal diagnoses from screening-score changes and orthopedic-specific from transferable perioperative studies. Findings: Multicomponent delirium prevention and coordinated perioperative assessment and recovery support provide the strongest clinical foundation. REGAIN, ENGAGES, the multicenter ketamine trial, and the minocycline trial were neutral for their relevant delirium or cognitive prevention outcomes. Signals from smaller studies of dexmedetomidine, peripheral nerve blocks such as the pericapsular nerve group (PENG) block, intranasal insulin, transcutaneous electrical acupoint stimulation (TEAS), repetitive transcranial magnetic stimulation (rTMS), and specific probiotic formulations require replication and safety assessment. Observational hemodynamic and biomarker findings do not establish preventive efficacy. Conclusion: Care should combine guideline-supported delirium prevention with individualized supportive measures. Research priorities include standardized neurocognitive diagnosis, externally validated prediction models, and multicenter orthopedic trials that measure cognition, function, and harms.
SN - 1664-2295
ER -