Recently, we read with great interest the well-written review article published in the November 8, 2018 edition of the Clinical Interventions in Aging by Kotekar and colleagues titled “Postoperative cognitive dysfunction–current preventive strategies”. 1 The article elegantly addressed the current preventive strategies for postoperative cognitive dysfunction (POCD). The authors concluded that the best preventive strategies for POCD may involve early recognition and management of potential perioperative risk factors, such as intraoperative anesthetic monitoring of the depth of anesthesia, Enhanced Recovery After Surgery and a multidisciplinary collaboration. Furthermore, the authors proposed that pharmacological interventions may be effective preventative and therapeutic strategies to attenuate POCD. We appreciate the efforts of the authors and would like to present our opinion on the review. POCD is a highly prevalent condition with significant impact on the prognosis of elderly patients undergoing an operation, experiencing problems with memory, concentration, information processing, language comprehension, and social integration that can last for months or may even be permanent. Chronic neuroinflammation and accompanying accumulation of amyloid-β (Aβ) and phosphorylation of tau protein secondary to surgery and anesthesia are strongly implicated in the pathophysiology of POCD. 2 The exact cascade by which surgical stress and anesthesia induce neuroinflammation in association with POCD remains unknown. Boosting degenerative systemic immune response in elderly patients may be a potential pharmacological strategy in treating POCD. Although previous studies have highlighted the role of the systemic immune response in inducing neuroinflammation, these results still did not show a significant association between systemic immune response and neuroinflammation. 3, 4 A famous study revealed that surgery-induced neuroinflammation was associated with infiltration of peripheral macrophages. 5 POCD is commonly observed in perioperative care in elderly patients; therefore, a limitation of this study is that they did not use aged mice as an experimental animal model of POCD. 2 Furthermore, elderly individuals more frequently present a degenerative systemic immune system and resident microglial priming in the aging brain, rather than the migration of peripheral macrophages, may have an important role in cognitive deficits after surgery. 6 Normal microglia respond to and degrade Aβ by phagocytosis; however, primed microglia become more proinflammatory and less phagocytic. 7 Current anti-