Liver Fibrosis Predicts Cognitive Function Following Bariatric Surgery: A Preliminary Investigation

Abstract

Objective: Obesity is a well-established risk factor for poor neurological outcomes, and bariatric surgery has been shown to improve many aspects of cognitive function. Factors underlying improved cognition following surgery are not yet fully established. A recent study of bariatric surgery patients demonstrated lower preoperative alkaline phosphatase concentrations were linked to greater postoperative cognitive improvement, but this link has not been examined via liver biopsy. The current study examined postoperative cognitive function in individuals with and without fibrosis at the time of bariatric surgery. It expected that those with fibrosis would demonstrate poorer postoperative cognition. Methods: Thirty-six bariatric surgery patients underwent routine liver biopsy at the time of surgery and completed cognitive testing 1 month postoperatively. Results: Bariatric surgery patients with fibrosis demonstrated poorer performance on a task of executive function (maze errors, P 5 0.01) and verbal memory (recognition memory, P 5 0.01). Conclusions: Bariatric surgery patients with fibrosis demonstrated poorer cognition following surgery, providing further evidence for the connection between liver disease and cognitive function. Future work examining mechanisms underlying bariatric postoperative cognitive changes should include examination of broader metabolic functions, particularly liver function.

Attention Deficit Hyperactivity Disorder Prevalence and Correlates Pre- and Post-Bariatric Surgery: A Comparative Cross-Sectional Study

“…It is reasonable to assume that postoperative cognitive improvement in attention and memory might have impacted the self-report on the respective CAARS subscale, possibly by way of improved prefrontal top-down control. The mechanisms for cognitive dysfunction in severely obese individuals and of improved cognition following bariatric surgery are not well understood and are the topic of ongoing research [43,44]. In addition to the potential contribution of medical comorbidities and mental disorders (such as depression), it has also been suggested that the greater presence of ADHD may account for some of the cognitive difficulty observed in this population [43].…”

A review of the psychosocial aspects of clinically severe obesity and bariatric surgery.

“…Encouragingly, several studies have found improvements in cognitive functioning with the substantial weight loss seen with bariatric surgery (Alosco et al, 2014; Gunstad et al, 2011). A number of mechanisms for this improvement have been offered, including postoperative amelioration of liver pathology, glucoregulation, hypertension, and sleep apnea (Spitznagel, Gunstad, Manderino, & Heinberg, 2015).…”