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Clinical Trial
. 2020 May;34(5):2248-2257.
doi: 10.1007/s00464-019-07015-2. Epub 2019 Jul 31.

Short-term improvements in cognitive function following vertical sleeve gastrectomy and Roux-en Y gastric bypass: a direct comparison study

Kimberly R Smith  1 , Timothy H Moran  2 , Afroditi Papantoni  2 , Caroline Speck  2 , Arnold Bakker  2 , Vidyulata Kamath  2 , Susan Carnell  2 , Kimberley E Steele  3   4
Affiliations
Clinical Trial

Short-term improvements in cognitive function following vertical sleeve gastrectomy and Roux-en Y gastric bypass: a direct comparison study

Kimberly R Smith et al. Surg Endosc. 2020 May.

Abstract

Background: Cognitive deficits are observed in individuals with obesity. While bariatric surgery can reverse these deficits, it remains unclear whether surgery type differentially influences cognitive outcome. We compared the extent to which vertical sleeve gastrectomy (VSG) and Roux-en Y gastric bypass (RYGB) ameliorated cognitive impairments associated with obesity.

Methods: Female participants approved for VSG (N = 18) or RYGB (N = 18) were administered cognitive measures spanning the domains of attention [Hopkins Verbal Learning Test (HVLT) Trial 1 and Letter Number Sequencing], processing speed [Stroop Color Trial, Symbol Digit Modalities Test, and Trail Making Part A], memory [HVLT Retained and HVLT Discrimination Index], and executive functioning (Stroop Color Word Trials and Trail Making Part B-A) prior to surgery and at 2 weeks and 3 months following surgery. Scores for each cognitive domain were calculated and compared between surgical cohorts using repeated measures analyses of variance.

Results: Significant weight loss was observed 2 weeks and 3 months following RYGB and VSG and was accompanied by improvements in processing speed and executive functioning. Patients who received RYGB also experienced improved attention as early as 2 weeks, which persisted at 3 months. This was not observed in individuals who underwent VSG. No changes in memory were observed from baseline measures in either group.

Conclusions: This is the first report of cognitive improvements following VSG and the first direct comparison of cognitive improvements following RYGB and VSG. Short-term improvements in specific domains of cognitive function are observed at the beginning of the active weight loss phase following bariatric surgery that persisted to 3 months. The anatomical distinction between the two surgeries and resulting differential metabolic profiles may be responsible for the improvements in attention observed following RYGB but not following VSG.

Keywords: Bariatric surgery; Cognition; Roux-en Y gastric bypass; Vertical sleeve gastrectomy.

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Conflict of interest statement

Disclosures Kimberly R. Smith, Timothy H. Moran, Afroditi Papantoni, Caroline Speck, Arnold Bakker, Vidyulata Kamath, Susan Carnell, and Kimberley E. Steele have no conflicts of interest and financial ties to disclose.

Figures

Fig. 1
Fig. 1
Similar significant changes in weight are observed at 2 weeks and 3 months following RYGB (red, mean ± SE) and VSG (blue mean ± SE) as measured by a total pounds lost, b BMI point loss, c percent total weight loss, and d percent excess weight loss (Color figure online)
Fig. 2
Fig. 2
Mean ± SE performance in the cognitive domain of attention, as assessed by the a Hopkins Verbal Learning Test (HVLT) Trial 1 and b Letter Number Sequencing (LNS), significantly improved with time in participants who received RYGB (red solid line), but not VSG (blue dashed line) (Color figure online)
Fig. 3
Fig. 3
Mean ± SE performance in the cognitive domain of processing speed, as assessed by the a Color Trial of the Stroop Color and Word Test (SCWT), b Symbol Digit Modalities Test (SDMT), and c Trail Making Test (TMT) Part A, significantly improved with time following RYGB (red solid line) and VSG (blue dashed line) (Color figure online)
Fig. 4
Fig. 4
Mean ± SE performance in the cognitive domain of executive functioning, as assessed by the a Color Word Trial of the Stroop Color and Word Test (SCWT) and b Trail Making Test (TMT) Part B-Part A, significantly improved with time following RYGB (red solid line) and VSG (blue dashed line) (Color figure online)
Fig. 5
Fig. 5
Mean ± SE performance in the cognitive domain of memory, as assessed by the a Hopkins Verbal Learning Test (HVLT) retained and b HVLT discrimination index, did not change following RYGB (red solid line) or VSG (blue dashed line) (Color figure online)
Fig. 6
Fig. 6
Mean ± SE overall cognitive performance at 2 weeks and 3 months following RYGB (red solid line) and VSG (blue dashed line) did not change (Color figure online)
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