We read with interest the recent contribution to your journal from Brown et al., who report an association between a postoperative increase in neurofilament light and worse cognitive outcomes at 1 yr after cardiac surgery.1  These results build on previous work which has shown that a postoperative increase in neurofilament light is similarly associated with an increased risk of delirium,2  and we congratulate the authors on their publication.

These findings are of particular importance, as they invite future interventional trials to use change in neurofilament light as a surrogate endpoint for long-term cognitive outcome after cardiac surgery. However, while the authors have adjusted their modeling for various factors and performed several post hoc sensitivity analyses following suggestions from the reviewers, we also wish to draw attention to another potential confounder that may have affected the authors’ results.

The relationship between predictive biomarkers of cognitive dysfunction and chronic...

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