{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T14:33:08Z","timestamp":1790346788732,"version":"4.1.0"},"reference-count":77,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:00:00Z","timestamp":1770163200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Perioperative neurocognitive disorders (PNDs), including delirium and postoperative cognitive dysfunction, affect 10\u201350% of elderly surgical patients and are associated with increased morbidity and mortality, as well as substantial healthcare costs. Despite their clinical significance, the underlying mechanisms remain incompletely understood and effective interventions are limited. This narrative review synthesizes current evidence on the pathophysiology, risk factors, and management strategies for PNDs. Methods: We conducted a comprehensive literature review of peer-reviewed publications addressing PND epidemiology, mechanisms, assessment, and interventions. Key databases were searched for studies published through 2025, with emphasis on systematic reviews, meta-analyses, and landmark clinical trials. Results: PND represents a spectrum of cognitive impairments with multifactorial etiology involving neuroinflammation, neurotransmitter imbalances, and blood\u2013brain barrier dysfunction. Advanced age, pre-existing cognitive impairment, and surgical factors constitute major risk domains. Validated assessment tools including the Confusion Assessment Method (CAM) and 4AT enable systematic detection. Multicomponent non-pharmacological interventions demonstrate 30\u201340% delirium reduction, while pharmacological prevention shows limited efficacy. Emerging evidence links perioperative delirium to accelerated long-term cognitive decline and increased dementia risk. Conclusions: PND represents a significant public health challenge requiring systematic attention in aging surgical populations. Evidence-based multicomponent interventions should be integrated into routine perioperative care pathways. Future research must elucidate mechanistic pathways linking acute delirium to chronic cognitive impairment and develop targeted therapies to preserve cognitive health in surgical populations.<\/jats:p>","DOI":"10.3390\/jcm15031253","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T17:20:14Z","timestamp":1770225614000},"page":"1253","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Perioperative Neurocognitive Disorders: A Narrative Review of Pathophysiology, Prevention, and Management Strategies"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-0215-5620","authenticated-orcid":false,"given":"Daniele Salvatore","family":"Patern\u00f2","sequence":"first","affiliation":[{"name":"Department of Anesthesia and Intensive Care, \u201cGiovanni Paolo II\u201d Hospital, 97100 Ragusa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2156-7554","authenticated-orcid":false,"given":"Luigi La","family":"Via","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Putaggio","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, \u201cGiovanni Paolo II\u201d Hospital, 97100 Ragusa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Piccolo","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, \u201cGiovanni Paolo II\u201d Hospital, 97100 Ragusa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1618-5391","authenticated-orcid":false,"given":"Giuseppe","family":"Scibilia","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, School of Medicine and Surgery, \u201cKore\u201d University, 94100 Enna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8127-5045","authenticated-orcid":false,"given":"Mario","family":"Lentini","sequence":"additional","affiliation":[{"name":"Department of Ear Nose and Throat, School of Medicine and Surgery, \u201cKore\u201d University, 94100 Enna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1251-0185","authenticated-orcid":false,"given":"Antonino","family":"Maniaci","sequence":"additional","affiliation":[{"name":"Department of Ear Nose and Throat, School of Medicine and Surgery, \u201cKore\u201d University, 94100 Enna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6346-1769","authenticated-orcid":false,"given":"Fabrizio","family":"Luca","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine and Surgery, \u201cKore\u201d University, 94100 Enna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia Concetta Lo","family":"Giudice","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, School of Medicine and Surgery, \u201cKore\u201d University, 94100 Enna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9331-2788","authenticated-orcid":false,"given":"Massimiliano","family":"Sorbello","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, \u201cGiovanni Paolo II\u201d Hospital, 97100 Ragusa, Italy"},{"name":"Department of Anesthesia and Intensive Care, School of Medicine and Surgery, \u201cKore\u201d University, 94100 Enna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"201","DOI":"10.2471\/BLT.15.159293","article-title":"Size and distribution of the global volume of surgery in 2012","volume":"94","author":"Weiser","year":"2016","journal-title":"Bull. 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