Anesthesiologists have long recognized that anesthesia and surgery can be associated with perioperative neurocognitive disorders (PNDs), which include delirium and changes in cognition up to 12 months postoperatively (formally referred to as postoperative cognitive dysfunction). The ASA Perioperative Brain Health Initiative aims to optimize cognitive recovery following surgery and anesthesia. One important question regarding perioperative brain health is whether exposure of older adults to anesthesia and surgery may also be associated with long-term postoperative changes in cognition. As this question is not amenable to evaluation by randomized clinical trials (it's hard to randomize patients to having surgery or not), insights must come from observational studies, which are valuable but have inherent limitations. Although a detailed literature review is beyond the scope of this Monitor article, we here summarize the results of an integrated series of studies from an investigative group at Mayo Clinic led by Dr. Sprung that examines three...

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