With the development of the aging society and the improvement of medical levels, there are a increasing number of elderly patients undergoing operations under anesthesia. Studies have found that elder patients are more susceptible to perioperative brain damage, but there is still lack of a comprehensive system to evaluate preoperative brain function. The current article discusses the physiological changes in the cerebral functions of elderly patients, preoperative brain function assessment, relevant clinical decision-making and the correlation between elderly brain function and perioperative brain damage. Then the article discusses the methods of perioperative cerebral function assessment in elderly patients, including risk identification, nutrition, and basic disease, so as to facilitate perioperative anesthetic decision, like medication decision and intraoperative management.