Research progress on the interaction between multiple organ-brain axes and perioperative neurocognitive disorders: a narrative review

Perioperative neurocognitive disorder (PND) is a common central nervous system complication during the perioperative period, characterized by memory decline, lack of concentration, and other cognitive deficits, which severely affect the quality of life and prognosis of patients. Its incidence remains high. Consequently, the prevention and treatment of PND, along with investigations into its etiology and mechanisms, have become prominent research areas. Recent studies suggest that the occurrence of PND is closely related to the interactions of multiple "important organ-brain axes," such as the gut-brain axis, liver-brain axis, lung-brain axis, heart-brain axis, spleen-brain axis, and kidney-brain axis. Dysfunction of these axes may affect brain homeostasis through neural, immune, and endocrine pathways, leading to perioperative cognitive impairment. Although some progress has been made, the mechanisms underlying PND remain intricate and not fully elucidated. This article aims to comprehensively review how different organ systems influence central nervous system function through multifaceted interactions. It also analyzes the pathological mechanisms of PND and proposes new strategies for perioperative brain protection, with the hope of improving postoperative cognitive function and patients' quality of life.