The perioperative sensory–cognitive interface: multimodal neuroimaging of hierarchical network reconfiguration in perioperative neurocognitive disorders
- 1Department of Anesthesiology, Institute of Translational Medicine, Shenzhen Second People’s Hospital/The First Affiliated Hospital of Shenzhen University
- 2Department of Anesthesiology, The First Affiliated Hospital of Jinan University
Abstract
Perioperative neurocognitive disorders (PNDs) are commonly attributed to neuroinflammation, cerebrovascular stress, anesthetic neurophysiology, and pre-existing brain vulnerability. These mechanisms identify important insults but do not fully explain how they become disturbances of attention, perception, memory, executive control, and fluctuating awareness. We examine whether changes at the sensory–cognitive interface help explain these symptoms, focusing on postoperative delirium (POD) and early recovery within the broader PND classification. The interface comprises distributed, bidirectional operations that transform sensory evidence into context-sensitive representations through thalamocortical routing, integration, attention, and association systems. The framework makes three testable predictions: sensory function should add explanatory value beyond frailty and brain burden; perioperative effects should vary across hierarchical levels and time rather than reflect uniform suppression; and within-person recovery trajectories should explain outcome better than isolated scans. Anesthetic state-transition studies show that primary sensory responses can persist while feedback, thalamic broadcasting, and distributed integration are disrupted, but whether these changes cause PND remains unproven. Direct perioperative MRI and EEG studies identify pre-existing dysconnectivity, altered sensory and association-network organization, abnormal slow-wave and auditory-feedback dynamics, and incomplete postoperative recovery; nevertheless, findings are heterogeneous and sensory-specific tasks remain uncommon. These observations are compatible with established vulnerability–perturbation models and suggest that symptoms may depend on which networks recover and when. Structural–functional connectivity (SC–FC) coupling is one candidate measurement, not an established biomarker or a requirement of the framework. Longitudinal studies integrating sensory phenotyping, domain-specific cognition, delirium surveillance, MRI, EEG, physiology, and molecular markers should test whether this framework adds reproducible value beyond vascular injury, diffuse arousal failure, and latent neurodegeneration.
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BibTeX
@article{luo2026perioperative,
title = {{The perioperative sensory–cognitive interface: multimodal neuroimaging of hierarchical network reconfiguration in perioperative neurocognitive disorders}},
author = {Nanbo Luo and Zhengjun Liu and Zhiheng Liu},
journal = {Frontiers in Neuroscience},
year = {2026},
month = oct,
doi = {10.3389/fnins.2026.1956385},
url = {https://www.frontiersin.org/articles/10.3389/fnins.2026.1956385/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The perioperative sensory–cognitive interface: multimodal neuroimaging of hierarchical network reconfiguration in perioperative neurocognitive disorders
AU - Nanbo Luo
AU - Zhengjun Liu
AU - Zhiheng Liu
PY - 2026
DA - 2026/10/21
JO - Frontiers in Neuroscience
DO - 10.3389/fnins.2026.1956385
UR - https://www.frontiersin.org/articles/10.3389/fnins.2026.1956385/full
AB - Perioperative neurocognitive disorders (PNDs) are commonly attributed to neuroinflammation, cerebrovascular stress, anesthetic neurophysiology, and pre-existing brain vulnerability. These mechanisms identify important insults but do not fully explain how they become disturbances of attention, perception, memory, executive control, and fluctuating awareness. We examine whether changes at the sensory–cognitive interface help explain these symptoms, focusing on postoperative delirium (POD) and early recovery within the broader PND classification. The interface comprises distributed, bidirectional operations that transform sensory evidence into context-sensitive representations through thalamocortical routing, integration, attention, and association systems. The framework makes three testable predictions: sensory function should add explanatory value beyond frailty and brain burden; perioperative effects should vary across hierarchical levels and time rather than reflect uniform suppression; and within-person recovery trajectories should explain outcome better than isolated scans. Anesthetic state-transition studies show that primary sensory responses can persist while feedback, thalamic broadcasting, and distributed integration are disrupted, but whether these changes cause PND remains unproven. Direct perioperative MRI and EEG studies identify pre-existing dysconnectivity, altered sensory and association-network organization, abnormal slow-wave and auditory-feedback dynamics, and incomplete postoperative recovery; nevertheless, findings are heterogeneous and sensory-specific tasks remain uncommon. These observations are compatible with established vulnerability–perturbation models and suggest that symptoms may depend on which networks recover and when. Structural–functional connectivity (SC–FC) coupling is one candidate measurement, not an established biomarker or a requirement of the framework. Longitudinal studies integrating sensory phenotyping, domain-specific cognition, delirium surveillance, MRI, EEG, physiology, and molecular markers should test whether this framework adds reproducible value beyond vascular injury, diffuse arousal failure, and latent neurodegeneration.
SN - 1662-453X
ER -