Work

The perioperative sensory–cognitive interface: multimodal neuroimaging of hierarchical network reconfiguration in perioperative neurocognitive disorders

Year: 2026

Type: article

Abstract: Perioperative neurocognitive disorders (PNDs) are commonly attributed to neuroinflammation, cerebrovascular stress, anesthetic neurophysiology, and pre-existing brain vulnerability. These mechanisms identify important insults but do not fully explain how they become disturbances of attention, perception, memory, executive control, and fluctuating awareness. We examine whether changes at the sensory–cognitive interface help explain these symptoms, focusing on postoperative delirium (POD) and early recovery within the broader PND classification. The interface comprises distributed, bidirectional operations that transform sensory evidence into context-sensitive representations through thalamocortical routing, integration, attention, and association systems. The framework makes three testable predictions: sensory function should add explanatory value beyond frailty and brain burden; perioperative effects should vary across hierarchical levels and time rather than reflect uniform suppression; and within-person recovery trajectories should explain outcome better than isolated scans. Anesthetic state-transition studies show that primary sensory responses can persist while feedback, thalamic broadcasting, and distributed integration are disrupted, but whether these changes cause PND remains unproven. Direct perioperative MRI and EEG studies identify pre-existing dysconnectivity, altered sensory and association-network organization, abnormal slow-wave and auditory-feedback dynamics, and incomplete postoperative recovery; nevertheless, findings are heterogeneous and sensory-specific tasks remain uncommon. These observations are compatible with established vulnerability–perturbation models and suggest that symptoms may depend on which networks recover and when. Structural–functional connectivity (SC–FC) coupling is one candidate measurement, not an established biomarker or a requirement of the framework. Longitudinal studies integrating sensory phenotyping, domain-specific cognition, delirium surveillance, MRI, EEG, physiology, and molecular markers should test whether this framework adds reproducible value beyond vascular injury, diffuse arousal failure, and latent neurodegeneration.

Source: Frontiers in Neuroscience

DOI: 10.3389/fnins.2026.1956385

Authors: Nanbo Luo, Zhengjun Liu, Zhiheng Liu

Institutions: Shenzhen University, First Affiliated Hospital of Jinan University, Shenzhen Second People's Hospital

Language: English

Topic: Intensive Care Unit Cognitive Disorders

Subfield: Critical Care and Intensive Care Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801