Review Proposes Sensory-Cognitive Framework for Postoperative Delirium

A review of perioperative brain-imaging and monitoring evidence proposes that postoperative delirium and related neurocognitive disorders may partly reflect abnormal reconfiguration of the brain’s sensory–cognitive interface. The framework focuses on postoperative delirium and early recovery within the broader category of perioperative neurocognitive disorders, which can involve disturbances of attention, perception, memory, executive control, and fluctuating awareness. It does not establish that changes in sensory processing cause these symptoms or reliably predict them in an individual patient.

The proposed interface comprises distributed, bidirectional operations that transform sensory evidence into context-sensitive representations. Thalamocortical routing, feedback, attention, association systems, and wider network integration help determine how sensory information is interpreted. Evidence from anesthetic state-transition studies shows that primary sensory responses may persist while feedback, thalamic broadcasting, and distributed integration are disrupted. This pattern suggests that detecting a stimulus and processing it meaningfully are separable, although it does not demonstrate a causal link between anesthetic-state changes and perioperative neurocognitive disorders.

Direct perioperative MRI and EEG studies have identified pre-existing dysconnectivity, altered organization of sensory and association networks, abnormal slow-wave and auditory-feedback dynamics, and incomplete postoperative recovery. The findings are heterogeneous, and sensory-specific experimental tasks remain uncommon. They are also compatible with established vulnerability–perturbation models: pre-existing brain vulnerability may interact with perioperative insults rather than produce a uniform response. The review therefore proposes three testable predictions: sensory-function measures should add explanatory value beyond frailty and brain burden; perioperative effects should differ across hierarchical network levels and over time; and within-person recovery trajectories should explain outcomes better than isolated scans.

Testing these predictions will require longitudinal studies combining sensory phenotyping, domain-specific cognition, delirium surveillance, MRI, EEG, physiology, and molecular markers. Researchers must also determine whether the framework adds reproducible value beyond vascular injury, diffuse failure of arousal, and latent neurodegeneration. Structural–functional connectivity coupling is identified as one candidate measurement, not an established biomarker or required component. The review’s central contribution is thus a systems-level hypothesis for future testing: symptoms may depend not only on whether basic sensory responses persist, but also on which networks transform those responses into context-sensitive information, how they recover after surgery, and when reconfiguration remains incomplete.

Subject of Research: Sensory–cognitive network reconfiguration in perioperative neurocognitive disorders

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

Article References: Luo, N., Liu, Z., & Liu, Z. (2026). The perioperative sensory–cognitive interface: multimodal neuroimaging of hierarchical network reconfiguration in perioperative neurocognitive disorders. Frontiers in Neuroscience, 20, Article 1956385. https://doi.org/10.3389/fnins.2026.1956385

Image Credits: AI Generated

DOI: 10.3389/fnins.2026.1956385

Keywords: postoperative delirium, perioperative neurocognitive disorders, sensory–cognitive interface, functional MRI, EEG monitoring, thalamocortical networks, network reconfiguration, anesthesia, neurocognitive recovery, perioperative, sensory, cognitive