Objective: To explore the correlation between intraoperative Narcotrend index (NI) and postoperative cognitive dysfunction (POCD) in elderly gynecological patients undergoing laparoscopic surgery. Methods: A total of 90 elderly gynecological patients undergoing laparoscopic surgery from March 2022 to October 2024 were selected as the research subjects. All patients were administered total intravenous anesthesia. They were randomly assigned to the NI D0 (64-56 ) group, NI D2 (45-37 ) group, and NI E0 (36-27 ) group by drawing lots, with 30 cases in each group. The general anesthesia conditions during surgery and heart rate and blood pressure values at baseline (T0), 5 minutes (T1), 15 minutes (T2), 30 minutes (T3), and at the end of surgery (T4) after reaching the predetermined NI values were recorded. The incidence of POCD after surgery was observed, and the levels of serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were detected. Results: The incidence rates of postoperative cognitive dysfunction (POCD) in the NI D0 group, NI D2 group, and NI E0 group were 60.00%, 23.33%, and 20.00%, respectively, with statistically significant differences (P < 0.05). The heart rates of all three groups at T1 to T3 were significantly lower than those at T0. The heart rate of the NI E0 group and NI D2 group at T3 was lower than that of the NI D0 group, with statistically significant differences (P < 0.05). The blood pressure of all three groups at T1 to T4 was significantly lower than that at T0. The blood pressure of the NI E0 group at T1 to T4 was lower than that of the NI D0 group and NI D2 group, with statistically significant differences (P < 0.05). There was no statistically significant difference in the operation time among the three groups (P > 0.05). The extubation time of the NI D0 group was shorter than that of the NI E0 group and NI D2 group, with statistically significant differences (P < 0.05). The recovery time of the NI D2 group was shorter than that of the NI E0 group, with statistically significant differences (P < 0.05). The levels of IL-6 and TNF-α increased on the first day after surgery. The levels of IL-6 and TNF-α in the NI E0 group and NI D2 group were lower than those in the NI D0 group, with statistically significant differences (P < 0.05). The level of TNF-α in the NI E0 group was lower than that in the NI D2 group, with statistically significant differences (P < 0.05).Conclusion: The appropriate depth of anesthesia guided by NI can significantly reduce the risk of postoperative POCD in elderly patients undergoing gynecological surgery. Maintaining NI at 45 to 37 can reduce the release of inflammatory factors, alleviate cognitive function impairment, maintain hemodynamic stability, and improve the quality of recovery.