We thank Mistry and Nair [1] for their comments on our umbrella review of 114 systematic reviews and meta-analyses of interventions aimed at reducing the incidence of peri-operative neurocognitive complications [2]. We appreciate their observations but we believe some of the assumptions underlying their comments warrant clarification. They note that when inconsistency reaches extreme levels, any overarching pooled estimate becomes difficult to interpret and may not reflect real-world practice.