Background: Aseptic surgical trauma provokes a homeostatic neuroinflammatory response to promote healing and protect the organism from further injury. When this response is dysregulated, harmful consequences can follow, including postoperative cognitive decline.
Sources of data: We performed a comprehensive search on PubMed related to postoperative cognitive dysfunction (POCD).
Areas of agreement: Although the precise pathogenic mechanisms for POCD remain unclear, certain risk factors are known.
Areas of controversy: The mechanisms that lead to exaggerated and persistent neuroinflammation and the best way to counteract it are still unknown. AREAS FOR DEVELOPING RESEARCH: It is imperative that we identify the underlying processes that increase the risk of cognitive decline in elderly surgical patients. In this review we explore non-resolution of inflammation as an underlying cause of developing exaggerated and persistent POCD. If interventions can be developed to promote resolution of neuroinflammation, the patient's postoperative recovery will be enhanced and long-term consequences can be prevented.
Keywords: cognitive decline; neurodegeneration; neuroinflammation; surgery, sleep.