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Neuro-cognitive dysfunction quite frequently occurs after major surgery particularly in elderly patients. Cognitive function monitoring becomes an important tool in the perioperative period, especially for patients undergoing neurosurgical procedures as these patients are at a greater risk because of the nature of surgery. Many cognitive assessment tools were described, but selecting a tool or combination of tools to assess depends on preoperative patient condition, availability of informant and post-operative course. The cognitive functioning monitoring is crucial for risk stratification to allow for subsequent prophylaxis, surveillance, and treatment of post-operative cognition dysfunction.