Mechanisms of perioperative neuronal injury and the search for therapies.

Perioperative neuronal injury includes both delirium and postoperative cognitive decline, and has profound potentially long-term effects on surgical patients and an economic cost. Recent advances have been made in the underlying biological causes of these injuries, including validation of biomarkers of neuronal damage such as neurofilament light, further understanding of the inflammatory pathways and mediators responsible for neuronal injuries, metabolic triggers, and the role of ischaemia. Several novel approaches to perioperative protection of brain health are also being trialled. We summarise the current evidence regarding the causes of neuronal injury, and work taking place related to its prevention and treatment.