Mrkobrada M, Chan MTV, Cowan D, et al. -In NeuroVISION, a prospective cohort study conducted in 12 academic centers in nine countries of 1,114 patients aged 65 years or older who underwent inpatient, elective, non-cardiac surgery and had brain MRI following surgery, researchers examined the correlation between perioperative covert stroke (ie, an acute brain infarct identified on an MRI following non-cardiac surgery in a patient with no clinical stroke symptoms) and cognitive decline 1 year following surgery. A perioperative covert stroke was noted in 78 of 1,114 participants. Among the patients who completed the 1-year follow-up, the occurrence of cognitive deterioration 1 year following surgery was seen in 29 of 69 individuals who had a perioperative covert stroke and in 274 of 932 patients who did not have a perioperative covert stroke. Covert stroke was also related to a progressed risk of perioperative delirium and overt stroke or transient ischaemic attack at a 1-year follow-up. Hence, perioperative covert stroke is correlated with a heightened risk of cognitive decline 1 year following non-cardiac surgery, and in one of 14 patients aged 65 years and older undergoing non-cardiac surgery perioperative covert stroke happened. The study is required to build prevention and management approaches for perioperative covert stroke.