What are common postoperative cognitive dysfunction risk factors and strategies to mitigate risk?

• A. Delirium risk is not related to age.
• B. Advanced age, preexisting cognitive impairment, polypharmacy, delirium risk; mitigate with orientation, sleep hygiene, analgesia optimization, early mobilization.
• C. POCD is not influenced by preexisting cognitive status.
• D. Delirium risk is inevitable and cannot be mitigated.

Answer: (B)

Risk of postoperative cognitive dysfunction rises when the brain has less reserve to cope with the stress of surgery and anesthesia. Advanced age and preexisting cognitive impairment reduce that reserve, making delirium and subsequent cognitive decline more likely. Polypharmacy adds to vulnerability by increasing exposure to sedatives, anticholinergic drugs, and drug interactions that can impair cognition. Delirium itself is a major risk factor and often precedes or amplifies POCD, so addressing delirium risk is central to preventing cognitive problems after surgery.

Mitigation focuses on practical, achievable steps that support orientation and reduce delirium triggers. Reorienting the patient to time and place helps maintain cognitive engagement. Sleep hygiene supports circadian rhythms and reduces confusion. Optimizing analgesia minimizes oversedation and delirium risk while still controlling pain. Early mobilization helps preserve function, circulation, and cognitive engagement, further lowering delirium duration and POCD risk.

The other statements conflict with established evidence: age does influence delirium risk; preexisting cognitive status does affect POCD risk; and delirium risk can be mitigated with appropriate perioperative care.