Postoperative cognitive dysfunction (POCD) is a common complication following surgery, particularly in elderly patients, characterized by a decline in cognitive functions such as memory, attention, and executive function. It is associated with prolonged hospital stays and increased mortality. POCD can occur within weeks to years after surgery and is linked to an increased risk of Alzheimer's disease. Research has focused on understanding the molecular mechanisms and potential preventive strategies for POCD. Factors contributing to POCD include age, type of surgery, anesthesia type, and postoperative pain. The pathogenesis of POCD involves central nervous system inflammation, neuronal apoptosis, synaptic plasticity impairment, abnormal modification of tau protein, chronic pain, and mitochondrial metabolic disorders. Various biomarkers, such as glial cell line-derived neurotrophic factor (GDNF), have been identified for early prediction of POCD. Prevention strategies include cognitive function training, rational use of perioperative drugs, and multidisciplinary collaboration. Current research highlights the importance of early identification and intervention to reduce the incidence of POCD. Effective prevention and treatment strategies are being explored, with a focus on targeted therapies targeting key pathological mechanisms such as the NF-κB pathway, caspase protein family, and tau protein. Future research aims to further develop targeted therapies to improve outcomes for patients with POCD.Postoperative cognitive dysfunction (POCD) is a common complication following surgery, particularly in elderly patients, characterized by a decline in cognitive functions such as memory, attention, and executive function. It is associated with prolonged hospital stays and increased mortality. POCD can occur within weeks to years after surgery and is linked to an increased risk of Alzheimer's disease. Research has focused on understanding the molecular mechanisms and potential preventive strategies for POCD. Factors contributing to POCD include age, type of surgery, anesthesia type, and postoperative pain. The pathogenesis of POCD involves central nervous system inflammation, neuronal apoptosis, synaptic plasticity impairment, abnormal modification of tau protein, chronic pain, and mitochondrial metabolic disorders. Various biomarkers, such as glial cell line-derived neurotrophic factor (GDNF), have been identified for early prediction of POCD. Prevention strategies include cognitive function training, rational use of perioperative drugs, and multidisciplinary collaboration. Current research highlights the importance of early identification and intervention to reduce the incidence of POCD. Effective prevention and treatment strategies are being explored, with a focus on targeted therapies targeting key pathological mechanisms such as the NF-κB pathway, caspase protein family, and tau protein. Future research aims to further develop targeted therapies to improve outcomes for patients with POCD.