Background　Along with the exacerbation of the aging process and the development of geriatric medicine， more and more elderly patients accepting surgeries from minor to major，as cures, but many of perioperative and postoperative complications have seriously affected their life quality during recovery period. Postoperative cognitive dysfunction （POCD） is one of the main complications， which is influenced by many factors， such as patients' basic situation， anesthesia and operation. A number of researches has proved that acute anemia is one of the moste important risk factors to POCD， though the underlying mechanism is not clearly understood.　Objective　In this paper， the latest studies of the pathogenesis of POCD and its association with intraoperative acute anemia were reviewed in order to provide reasonable and practical means for prevention and treatment of such complications.　Content　The main factors contribute to POCD and association between acute anemia and POCD，including the pathogenesis and treatment.　Trend　The dangerous critical value of anemia to POCD and transfusion thresholds still undefined at present， are helpful for therapeutic option for POCD and worth further exploration.