Mind matters: Navigating preoperative cognitive testing in elderly population

Abstract

Background: With more surgical procedures performed under general anesthesia in older adults, perioperative brain health has become a growing public health concern. This review is the first to synthesize cognitive screening tools specifically from the perspective of anesthesiology practice. Preoperative cognitive screening can identify individuals at risk of neurocognitive disorders, including postoperative delirium. Literature search: This narrative review, based on the PCC framework, examined cognitive assessment tools used preoperatively in the elderly. A structured literature search (2020–2024) conducted exclusively in the PubMed database, following PRISMA guidelines, identified 124 studies. Of these, 31 were excluded: 25 did not evaluate cognition preoperatively, 2 lacked defined tests, 2 omitted testing before surgery, and 2 involved patients younger than the geriatric age group. Discussion: The review reveals major gaps in cognitive evaluation practices for elderly patients before surgery. Although tools such as Mini-Cog, MOCA, and MMSE are commonly used, many lack validation in perioperative settings and do not fully address complex geriatric needs. Involvement of professionals outside anesthesiology underscores the fragmented nature of current approaches. Conclusion: Preoperative cognitive screening is increasingly recognized as essential in perioperative care. While existing tools offer practical value, standardized and validated instruments specific to surgical contexts are urgently needed. Improved screening may reduce neurocognitive complications and enhance outcomes for elderly patients by enabling anesthesiologists to identify cognitive risk factors early and tailor perioperative management accordingly.