Review Volume 12, Issue 15 pp 15797—15817

Perioperative neurocognitive dysfunction: thinking from the gut?

Xiaolin Xu1,4, , Yimin Hu2, , Enshi Yan3, , Gaofeng Zhan4, , Cunming Liu1, , Chun Yang1, ,

  • 1 Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
  • 2 Department of Anesthesiology, The Second Affiliated Changzhou People’s Hospital of Nanjing Medical University, Nanjing 213003, China
  • 3 Department of Anesthesiology, Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing 210029, China
  • 4 Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China

Received: March 18, 2020       Accepted: July 7, 2020       Published: August 15, 2020
How to Cite

Copyright © 2020 Xu et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


With the aging of the world population, and improvements in medical and health technologies, there are increasing numbers of elderly patients undergoing anaesthesia and surgery. Perioperative neurocognitive dysfunction has gradually attracted increasing attention from academics. Very recently, 6 well-known journals jointly recommended that the term perioperative neurocognitive dysfunction (defined according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition) should be adopted to improve the quality and consistency of academic communications. Perioperative neurocognitive dysfunction currently includes preoperatively diagnosed cognitive decline, postoperative delirium, delayed neurocognitive recovery, and postoperative cognitive dysfunction. Increasing evidence shows that the gut microbiota plays a pivotal role in neuropsychiatric diseases, and in central nervous system functions via the microbiota-gut-brain axis. We recently reported that abnormalities in the composition of the gut microbiota might underlie the mechanisms of postoperative cognitive dysfunction and postoperative delirium, suggesting a critical role for the gut microbiota in perioperative neurocognitive dysfunction. This article therefore reviewed recent findings on the linkage between the gut microbiota and the underlying mechanisms of perioperative neurocognitive dysfunction.


5-HT: 5-hydroxytryptamine; α7nAChR: α7 nicotinic acetylcholine receptor; APC: antigen presenting cells; APP: amyloid precuser protein; ASA: American Society of Anesthesiologists; BBB: blood-brain barrier; BDNF: brain-derived neurotrophic factor; CB2R: cannabinoid 2 receptor; CHAT: choline acetylase; CNS: central nervous system; CPB: cardiopulmonary bypass; CRP: C-reactive protein; DSM-5: Diagnostic and Statistical Manual of Mental Disorders, fifth edition; ENS: enteric nervous system; FMT: faecal microbiota transplantation; GABA: gamma amino butyric acid; GABA(A)Rs: γ-aminobutyric acid type A receptors; GALT: gut-associated lymphoid tissue; GR: glucocorticoid receptor; Hcy: homocysteine; HMGB1: high mobility group box-1 chromatin protein; HPA: hypothalamic-pituitary-adrenal; IBS: irritable bowel syndrome; IL: interleukin; LA: local anaesthesia; LPS: lipopolysaccharide; MAP: mean arterial pressure; MAPK: mitogen-activated protein kinase; MPTP: methyl-4-phenyl-1,2,3,6-tetrahydropyridine; Msr: methionine sulfoxide reductase; NF-κB: nuclear factor κB; NGAL: neutrophil gelatinase-associated apolipoprotein; NICE: National Institute of Health and Clinical Excellence; PACU: postanaesthesia care unit; PND: perioperative neurocognitive dysfunction; POCD: postoperative cognitive dysfunction; POD: postoperative delirium; RA: regional anaesthesia; ROS: reactive oxygen species; SCFA: short-chain fatty acids; SSRIs: selective serotonin reuptake inhibitors; TCAs: tricyclic antidepressants; TMAO: trimethylamine N-oxide; TNF: tumor necrosis factor.