Roy Bhaswati, Thedim Mariana, Liew Chiewlin, Kumar Rajesh, Vacas Susana
Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, CA, United States.
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
Front Neurosci. 2024 Nov 5;18:1454284. doi: 10.3389/fnins.2024.1454284. eCollection 2024.
Obese patients have worse outcomes after surgery and are at increased risk for perioperative neurocognitive disorders (PND). Our aim was to detail the cognitive trajectories of patients undergoing bariatric surgery (BS) and map distinct structural brain changes using magnetic resonance imaging (MRI) to better understand the association between the vulnerable brain, surgery, and the arc of PND.
Prospective pilot study with longitudinal comprehensive cognitive assessments and MRI were performed on obese patients scheduled for BS. We analyzed baseline cognitive function and high-resolution T1-/T2-weighted brain images on 19 obese patients [age, 54 (9) years, BMI, 40 (36, 42) kg m] and compared with 50 healthy control subjects [age, 52 (6) years; BMI, 25 (24, 27) kg m]. Patients were evaluated within five days of BS (baseline), immediately after (within 48h), and follow up at six months.
At baseline, obese patients had significant brain tissue changes seen in MRI and decreased cognitive scores compared to controls (MoCA 26 vs 28, = 0.017). Surgery induced further gray matter volume and brain tissue changes along with reduced cognitive scores within the immediate postoperative period (MoCA 26 vs 24, < 0.001). At six months, we observed reversal of brain alterations for most patients and a concomitant rebound of cognitive scores to patient's baseline status.
Bariatric surgery resulted in worsening of preexisting brain structural integrity and lower cognitive function for obese patients compared to baseline. These distinct brain lesions are consistent with specific domains of cognition. Most of these changes reverted to patient's baseline condition within six months after surgery.
肥胖患者术后预后较差，围手术期神经认知障碍（PND）风险增加。我们的目的是详细描述接受减肥手术（BS）患者的认知轨迹，并使用磁共振成像（MRI）绘制不同的脑结构变化，以更好地理解脆弱大脑、手术与PND病程之间的关联。
对计划接受BS的肥胖患者进行了前瞻性试点研究，包括纵向综合认知评估和MRI检查。我们分析了19例肥胖患者[年龄54（9）岁，体重指数（BMI）40（36，42）kg/m²]的基线认知功能和高分辨率T1加权/T2加权脑图像，并与50名健康对照者[年龄52（6）岁；BMI 25（24，27）kg/m²]进行比较。患者在BS术前五天（基线）、术后立即（48小时内）以及术后六个月进行评估。
在基线时，与对照组相比，肥胖患者在MRI上可见明显的脑组织变化，认知评分降低（蒙特利尔认知评估量表[MoCA]评分26分对28分，P = 0.017）。手术导致术后即刻灰质体积和脑组织进一步变化，同时认知评分降低（MoCA评分26分对24分，P < 0.001）。在六个月时，我们观察到大多数患者的脑部改变有所逆转，认知评分随之反弹至患者的基线状态。
与基线相比，减肥手术导致肥胖患者原有的脑结构完整性恶化，认知功能降低。这些明显的脑损伤与特定认知领域一致。这些变化大多在术后六个月内恢复到患者的基线状态。
