Background: Women are at higher risk than men for neurologic complications from cardiac operations. This study identified risk factors for neurocognitive dysfunction after cardiac operations in elderly women. Methods: One hundred thirteen postmenopausal women undergoing primary coronary artery bypass grafting, with or without valve operation, underwent psychometric testing and neurologic evaluation the day before operation and 4 to 6 weeks postoperatively. Risk factors assessed for neurologic complications included atherosclerosis of the ascending aorta and apolipoprotein ε4 genotype. Postoperative neurocognitive dysfunction was defined as the composite end point of a one standard deviation decrement from baseline on two or more psychometric tests or a new neurologic deficit. Results: Neurocognitive dysfunction was present in 25% of the women 4 to 6 weeks postoperatively. Women with a neurocognitive deficit tended to be older than those without a deficit (72.1 ± 8.1 vs 69.4 ± 8.9 years, p = 0.144) and were more likely to have mild atherosclerosis of the ascending aorta, a history of congestive heart failure, longer duration of cardiopulmonary bypass (CPB) and aortic cross-clamping, lower nadir blood pressure during CPB, higher rates of postoperative atrial fibrillation, and longer postoperative hospitalization. Mild atherosclerosis of the ascending aorta, duration of CPB, duration of aortic cross-clamping (p = 0.051), and length of postsurgical hospitalization were independently associated with postoperative neurocognitive dysfunction. Conclusions: Mild atherosclerosis of the ascending aorta, duration of CPB, aortic cross-clamping time, and length of hospitalization, but not apolipoprotein ε4 genotype, identified risk for neurocognitive dysfunction after cardiac operation in postmenopausal women.