**4. Concluding remarks**

POCD is increasingly recognized as one of the common complications in geriatric patients despite the lack of strategy for prevention and management. Due to these limitations, preoperative management should be focused on promoting an early recognition of the patients at risk, and preventative measures should be taken from a multimodal approach comprising collaboration between the anaesthesiologist, surgeon, geriatricians and inclusion of family in the postoperative care plan in order to improve overall recovery and avoid long-term sequelae of POCD [2, 6, 10, 66]. Furthermore, it is recommended that patients at high risk for POCD should get preoperative discussion of this issue, allowing patients to make cognitively demanding decisions before surgery [2]. In addition, in line with the positive effects of cognitive interventions in both human and animal models, "pre-surgical rehabilitation" must be encouraged when possible in order to minimize the risk of POCD occurrence and its effects on overall recovery after surgery [2]. Moreover, promising new approaches such as the utilization of the relationship between neuroinflammation and miRNA expression should not be overlooked, in order to understand and discover new treatments. Deregulation of certain miRNAs may be associated with POCD development.

While both cardiac surgery and noncardiac surgery have been associated with POCD, the effects of each seem to affect different cognitive domains and in consequence may originate from different causes or mechanisms [25]. Moreover, the difficulty extrapolating the knowledge gathered through preclinical studies and animal models to human cases and the translation of these findings into therapeutic treatment for POCD points to the need for further work is needed. So far, the surgery-induced neuroinflammation processes including the microglial activation pathways seem to be the most promising therapeutic targets in the management of POCD.
