Cognitive improvement following sleeve gastrectomy and roux-En-Y gastric bypass procedures

Introduction: South Asia has noted an increasing prevalence of obesity and employment of bariatric surgery (BS) procedures. Prior studies have shown improvement in memory, executive function and attention, after Roux-en-Y gastric bypass (RYGB) operation in the Western population. However, there is a scarcity of data on cognitive improvement following BS in a non-Western population. Objective: The objective of the study is to evaluate changes in cognitive functions of patients with severe obesity, after BS. Study Setting: Tertiary-care Academic Center, India. Methodology: A prospective study of patients undergoing BS was conducted. Specific neurocognitive tests (Mini-mental Status Examination, Standard progressive matrices, Controlled Oral Word Association Test, and Post Graduate Institute Memory Scale test) were used to assess cognitive status at baseline (preoperatively), and at 3, 6, and 12 months. Results: Fifty-three patients were enrolled in the study, out of which 50 had completed 1 year of follow-up at the time of analysis (n = 50). Thirty-six patients (72%) were females. The median age was 42 years, and the mean preoperative body mass index (BMI) was 45.5 ± 6.3 kg/m2. 40 patients underwent SG, while 10 underwent RYGB procedure. At baseline, the study cohort had impairment of abstract reasoning, attention, and verbal retention, as compared to normative data. At 1 year after surgery, the mean BMI was 29.1 ± 2.6 kg/m2. There was a significant (P < 0.05) improvement in most cognitive domains (global cognitive functioning, abstract reasoning, attention/concentration, and memory function). However, improvement in language function was not found to be significant across the follow-up duration of 12 months (P = 0.35). Conclusions: Individuals with severe obesity experience baseline impairment in cognitive functions. Similar to results from the Western population, BS (RYGB and SG) results in a significant improvement in multiple cognitive domains even in a non-Western population.