Postoperative cognitive dysfunction (POCD) is a common complication following surgery, particularly in elderly individuals, characterized by a decline in cognitive functions such as memory, attention, and coordination. The prevalence of POCD can reach up to 40% within one week after cardiovascular surgery and remains high at 17% three months post-surgery. POCD is associated with increased mortality and prolonged hospital stays, and it may also exacerbate the risk of Alzheimer's disease (AD). Research has identified various risk factors for POCD, including patient age, surgical type, anesthesia modality, and pain intensity. The pathogenesis of POCD involves central inflammation, neuronal apoptosis, synaptic plasticity impairment, abnormal tau protein modification, chronic pain, mitochondrial metabolic disorders, and neurotrophic factor dysfunction. Current prevention strategies include identifying biomarkers, cognitive function training, rational use of perioperative medications, and multidisciplinary collaboration. Despite significant progress, further research is needed to develop targeted therapies for POCD.Postoperative cognitive dysfunction (POCD) is a common complication following surgery, particularly in elderly individuals, characterized by a decline in cognitive functions such as memory, attention, and coordination. The prevalence of POCD can reach up to 40% within one week after cardiovascular surgery and remains high at 17% three months post-surgery. POCD is associated with increased mortality and prolonged hospital stays, and it may also exacerbate the risk of Alzheimer's disease (AD). Research has identified various risk factors for POCD, including patient age, surgical type, anesthesia modality, and pain intensity. The pathogenesis of POCD involves central inflammation, neuronal apoptosis, synaptic plasticity impairment, abnormal tau protein modification, chronic pain, mitochondrial metabolic disorders, and neurotrophic factor dysfunction. Current prevention strategies include identifying biomarkers, cognitive function training, rational use of perioperative medications, and multidisciplinary collaboration. Despite significant progress, further research is needed to develop targeted therapies for POCD.