Postoperative neurocognitive disorder is a disease that frequently develops in older patients during the perioperative period. Postoperative neurological disorders neurological most severe complications include as delirium, cognitive dysfunction, acute cerebral ischemic stroke, and hemorrhagic stroke. Milder complications are anxiety, personality changes and impaired memory.
Alterations in cognitive functions are common in the perioperative course. Although often unnoticed by physicians, these alterations have gained increased interest, both by clinicians and scientists, and knowledge of the preventive measures of postoperative cognitive decline has become mandatory for anesthetists and surgeons.
Despite advancements in understanding postoperative neurocognitive disorder, this disorder's mechanisms remain unclear, including pathophysiological processes such as central synaptic plasticity and function, neuroinflammation, excitotoxicity, and neurotrophic support.
Growing evidence suggests that microenvironmental changes in exosomes and microRNAs are major factors for postoperative neurocognitive disorder induction in older individuals.
Exosomes are carriers for transporting different bioactive molecules between nerve cells in the microenvironment and maintaining intercellular communication and tissue homeostasis.
This article reviews the effects of exosomes and miRNAs on the brain microenvironment in postoperative neurocognitive disorder and has important implications to improve postoperative neurocognitive disorder diagnosis, as well as to develop targeted therapy of this disorder.