This project is designed as a prospective, single-center observational study. The cohort will consist of 500 consenting subjects ≥ 65 years of age who present to the Brigham and Women's Hospital Weiner Center for Preoperative Evaluation (CPE) prior to elective thoracic surgery (specifically, thoracoscopic lung resection, lobectomy, thoracotomy, or esophagectomy) and to neurological posterior thoracolumbar spine surgery by neurosurgeons Dr. Groff, Dr. Lu and Dr. Chi. 250 subjects undergoing thoracic surgery will be recruited and 250 subjects undergoing neurological posterior thoracolumbar spine surgery will be recruited (500 total). These ages are chosen as significant clinical data demonstrate increased cognitive impairment in community dwelling elders. Eligibility criteria include: patients ≥ 65 years of age with an American Society of Anesthesiologists (ASA) physical status classification of I-III presenting for elective thoracic surgery or spinal surgery. Exclusion criteria will include planned Intensive Care Unit (ICU) admission postoperatively, history of stroke or brain tumor, uncorrected vision or hearing impairment (unable to see pictures or read or hear instructions); limited use of the dominant hand (limited ability to draw); and or inability to speak, read, or understand English.