Introduction: Postoperative cognitive dysfunction (POCD) represents a significant complication following surgical procedures. This study aimed to compare the incidence of POCD between anesthesia using sevoflurane alone and a combination of sevoflurane with dexmedetomidine, in addition to propofol based sedation, among elderly patients undergoing Orthopedic and General Surgery. Materials and Methods: 99 patients, aged between 65 and 80 years, who underwent Orthopedic and General Surgery, along with 33 nonsurgical controls, were included in the study. The patients were randomly assigned to three groups in a 1:1:1 ratio. Participants were allocated into one of three anesthesia groups (P, PS, PSD) or a control group (C) comprising healthy individuals. Group P received propofol and remifentanil, Group PS received propofol, remifentanil, and sevoflurane, and Group PSD received propofol, remifentanil, sevoflurane, and dexmedetomidine. Cognitive function was assessed using several scales both before and three days after surgery. Additionally, participants were interviewed via telephone at 7 days, 30 days, and 90 days postoperatively.