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In this perspective article, we propose a dual-pathway theoretical model\u2014central nervous system vulnerability and peripheral stress amplification\u2014to reframe the understanding of POCD pathogenesis. In older adults, POCD rarely stems from a single cause. Instead, it arises from a \u201csecond hit\u201d process, in which pre-existing central nervous system vulnerabilities (e.g., neurodegenerative pathology and reduced cognitive reserve) interact with perioperative peripheral stressors (e.g., trauma, surgical stress, and anesthetic exposure) through interfaces such as the blood\u2013brain barrier and neuroimmune circuits. Guided by this dual-pathway framework, future research should move from isolated risk factor screening toward dynamic, multidimensional, and individualized risk stratification, and explore sequential intervention strategies that target both pathways.<\/jats:p>","DOI":"10.3389\/fnagi.2026.1841750","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T05:45:45Z","timestamp":1784267145000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk factors for postoperative cognitive dysfunction in geriatric trauma: a dual-pathway perspective"],"prefix":"10.3389","volume":"18","author":[{"given":"Xiao-dong","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, The Second Affiliated Hospital of Inner Mongolia Medical University","place":["Hohhot, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiao","family":"Xue","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, The Second Affiliated Hospital of Inner Mongolia Medical University","place":["Hohhot, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting-ting","family":"Qiao","sequence":"additional","affiliation":[{"name":"College of Humanities and Education, Inner Mongolia Medical University","place":["Hohhot, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang-jiao","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, The Second Affiliated Hospital of Inner Mongolia Medical University","place":["Hohhot, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao-yan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, The Second Affiliated Hospital of Inner Mongolia Medical University","place":["Hohhot, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Qiu","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, The Second Affiliated Hospital of Inner Mongolia Medical University","place":["Hohhot, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1016\/j.ebiom.2018.10.021","article-title":"Surgery, neuroinflammation and cognitive impairment.","volume":"37","author":"Alam","year":"2018","journal-title":"EBioMedicine"},{"key":"B2","doi-asserted-by":"publisher","first-page":"21514593211058947","DOI":"10.1177\/21514593211058947","article-title":"Review of postoperative delirium in geriatric patients after hip fracture treatment.","volume":"13","author":"Albanese","year":"2022","journal-title":"Geriatr. 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