To Background

Obesity is a global epidemic and is associated with cognitive impairment and dementia. It remains unknown whether weight loss interventions, such as bariatric surgery, can mitigate cognitive impairment.

Objectives

We aimed to determine the effect of surgical weight loss on cognition in individuals with class II/III obesity.

Design

We performed a prospective cohort study of participants who underwent bariatric surgery. At baseline and two years following surgery, participants completed metabolic risk factor and neuropsychological assessments.

Setting

Participants were enrolled from an academic suburban bariatric surgery clinic.

Participants

There were 113 participants who completed baseline assessments and 87 completed two-year follow-up assessments (66 in-person and 21 virtual) after bariatric surgery. The mean (SD) age was 46.8 (12.5) years and 64 (73.6%) were female.

Intervention

Bariatric surgery. There were 77 (88.5%) participants that underwent sleeve gastrectomy and 10 (11.5%) that underwent gastric bypass surgery.

Measurements

Cognition was assessed using the NIH toolbox cognitive battery (NIHTB-CB) and the Rey Auditory Verbal Learning Test (AVLT). The primary outcome was the change in NIHTB-CB fluid composite score before and after surgery.

Results

The primary outcome, NIHTB-CB composite score, was stable following bariatric surgery (−0.4 (13.9), p=0.81,n=66). Among secondary outcomes, the NIHTB-CB dimensional card sorting test (executive function assessment), improved (+6.5 (19.9), p=0.01, n=66) while the Rey AVLT delayed recall test (memory assessment) declined (−0.24 (0.83), p=0.01, n=87) following surgery. Improvements to metabolic risk factors and diabetes complications were not associated with improvements to NIHTB-CB composite score. The other 4 NIHTB-CB subtests and Rey AVLT assessments of auditory learning and recognition were stable at follow-up.

Conclusions

Following bariatric surgery, the age-adjusted composite cognitive outcome did not change, but an executive subtest score improved. These results suggest that bariatric surgery may mitigate the natural history of cognitive decline in individuals with obesity, which is expected to be faster than normal aging, but confirmatory randomized controlled trials are needed. The decline in delayed recall also warrants further studies to determine potential differential effects on cognitive subtests.

中文翻译：

---

手术减肥对 II/III 级肥胖患者认知的影响

背景

肥胖是一种全球流行病，与认知障碍和痴呆有关。目前尚不清楚减肥干预措施（例如减肥手术）是否可以减轻认知障碍。

目标

我们的目的是确定手术减肥对 II/III 级肥胖患者认知的影响。

设计

我们对接受减肥手术的参与者进行了一项前瞻性队列研究。在基线和手术后两年，参与者完成了代谢危险因素和神经心理学评估。

环境

参与者是从郊区一家学术减肥手术诊所招募的。

参加者

减肥手术后，有 113 名参与者完成了基线评估，87 名参与者完成了两年随访评估（66 名现场评估和 21 名虚拟评估）。平均 (SD) 年龄为 46.8 (12.5) 岁，其中 64 名 (73.6%) 为女性。

干涉

减肥手术。有 77 名（88.5%）名参与者接受了袖状胃切除术，10 名（11.5%）名参与者接受了胃绕道手术。

测量

使用 NIH 工具箱认知电池 (NIHTB-CB) 和雷伊听觉语言学习测试 (AVLT) 评估认知能力。主要结果是手术前后 NIHTB-CB 液体综合评分的变化。

结果

主要结局，NIHTB-CB 综合评分，在减肥手术后保持稳定（-0.4 (13.9)，p=0.81，n=66）。在次要结果中，NIHTB-CB 维度卡片分类测试（执行功能评估）改善（+6.5 (19.9)，p=0.01，n=66），而 Rey AVLT 延迟回忆测试（记忆评估）下降（−0.24（ 0.83), p=0.01, n=87) 手术后。代谢危险因素和糖尿病并发症的改善与 NIHTB-CB 综合评分的改善无关。其他 4 项 NIHTB-CB 子测试和 Rey AVLT 听觉学习和识别评估在随访中保持稳定。

结论

减肥手术后，年龄调整后的综合认知结果没有改变，但执行分项测试得分有所提高。这些结果表明，减肥手术可以减轻肥胖患者认知能力下降的自然史，预计其速度比正常衰老更快，但需要进行验证性随机对照试验。延迟回忆的下降也需要进一步研究，以确定对认知子测试的潜在差异影响。