| Summary: | <i>Background and Objectives:</i> The aim of this study is to identify risk factors for the development of delayed neurocognitive recovery (dNCR). <i>Methods:</i> 140 patients underwent neurocognitive evaluations (Adenbrooke, MoCa, trial making, and CAM test) and middle cerebral artery (MCA) blood flow velocity (BFV) measurements, one day before cardiac surgery. BFV was re-evaluated after anesthesia induction, before the beginning, middle, end, and after cardiopulmonary bypass (CPB) and postsurgery. To measure glial fibrillary acidic protein (GFAP) and neurofilament heavy chain (Nf-H), blood samples were collected after anesthesia induction, 24 and 48 h after the surgery. Neurocognitive evaluation was repeated 7–10 days after surgery. According to the results, patients were divided into two groups: with dNCR (dNCR group) and without dNCR (non-dNCR group). <i>Results:</i> 101 patients completed participation in this research. GFAP increased in both the non-dNCR group (<i>p</i> < 0.01) and in the dNCR group (<i>p</i> < 0.01), but there was no difference between the groups (after 24 h, <i>p</i> 0.342; after 48 h, <i>p</i> 0.273). Nf-H increased in both groups (<i>p</i> < 0.01), but there was no difference between them (after 24 h, <i>p</i> = 0.240; after 48 h, <i>p</i> = 0.597). MCA BFV was significantly lower in the dNCR group during the bypass (37.13 cm/s SD 7.70 versus 43.40 cm/s SD 9.56; <i>p</i> = 0.001) and after surgery (40.54 cm/s SD 11.21 versus 47.6 cm/s SD 12.01; <i>p</i> = 0.003). Results of neurocognitive tests correlated with CO<sub>2</sub> concentration (Pearson’s r 0.40, <i>p</i> < 0.01), hematocrit (r 0.42, <i>p</i> < 0.01), MCA BFV during bypass (r 0.41, <i>p</i> < 0.01), and age (r −0.533, <i>p</i> < 0.01). The probability of developing dNCR increases 1.21 times with every one year of increased age (<i>p</i> < 0.01). The probability of developing dNCR increases 1.07 times with a decrease of BFV within 1 cm/s during bypass (<i>p</i> = 0.02<i>)</i><i>.</i><b><i> </i></b><i>Conclusion</i>:<b> </b>Risk factors contributing to dNCR among the tested patients were older age and middle cerebral artery blood flow velocity decrease during bypass.
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