High levels of preoperative oxaloacetate and 2-AAA also were associated with postoperative decreased MoCA (β: 0.022, 95% CI: 0.005–0.04, P = 0.013 for oxaloacetate; β: 0.077, 95%CI: 0.016–0.137, P = 0.014 for 2-AAA) and MMSE (β: 0.024, 95% CI: 0.009–0.039, P = 0.002 for oxaloacetate; β: 0.083, 95% CI: 0.032–0.135, P = 0.002 for 2-AAA) scores after adjusting for age, education level, and operation time. Here, DOCK3 is linked to triple-A syndrome.