Objective To prospectively investigate neurological complications (NC) after off-pump coronary artery bypass grafting (OPCAB), including types of NC, incidence rates, risk factors, prevention and treatment measures. Methods A total of 82 elderly patients with OPCAB admitted to Department of Cardiosurgery in Anzhen Hospital between June and October 2010 were evaluated. Firstly, risk factors of NC were collected before operation. Secondly, nervous system physical examination, cerebral perfusion examinations, cognitive tests and anxious and depression scale were performed before and after OPCAB; NC occurrence and types were determined after surgery. Thirdly, all patients were divided into two groups according to whether there was NC occurrence after operation, and univariate analysis was used to compare the two groups. Results The total incidence rate of postoperative NC was 17.01%(14/82), with no case dead. The incidence of postoperative cognitive dysfunction(POCD), anxiety and depression, hypoxic ischemic encephalopathy, and ischemic cerebrovascular disease were 14.63%(12/82), 6.10%(5/82), 3.66%(3/82) and 1.22%(1/82), respectively. Single factor analysis indicated that there were statistically significant differences in stroke history, CT scan lesions and diabetes between NC group and non-NC group. Statistical significance also observed in rTTP. Conclusion Preoperative screening is important for OPCAB patients. Improvement of the laboratory examination, performance cerebral perfusion and so on can help to screen out high-risk patients before surgery and provide them with appropriate prophylaxis. OPCAB is relatively safe for nerve system, but more clinical data is needed for further exploration.