Duan Yanjie, Feng Wenhuan, Sun Xitai, Zhang Bing, Zhang Zhou, Miao Yingwen, Wu Tianyu, Zhang Wen, Zhu Wenhui, Tong Xuewei, Li Xin, Bi Yan
Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China.
Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China.
Obes Surg. 2025 Jun 13. doi: 10.1007/s11695-025-07964-9.
Evidence has demonstrated that patients with obesity exhibited cognitive impairment and cerebral damage. Bariatric surgery is an effective intervention for obesity and is associated with cognitive improvement. However, the underlying mechanisms by which bariatric surgery improves cognitive function remain unclear. This study aimed to evaluate cognitive alterations in patients with obesity before and after bariatric surgery, and to further explore the associations among fat reduction, cognitive alterations, and underlying cerebral changes.
We conducted an exploratory study on 23 patients with obesity who underwent bariatric surgery. These patients received anthropometric measurements, detailed cognitive assessments, and functional magnetic resonance imaging (fMRI) scans at baseline and 12 months post-surgery to evaluate neuroimaging and cognitive changes.
Compared to baseline, patients with obesity exhibited significant improvements in immediate and delayed memory following bariatric surgery. fMRI scans also revealed increased left hippocampal volume and enhanced right hippocampal activation in patients with obesity postoperatively. Furthermore, these improvements in cognitive function and hippocampal activation were associated with reductions in visceral fat (β = -0.122, 95% bootstrap CI: -0.210, -0.030) and hepatic steatosis (β = -0.147, 95% bootstrap CI: -0.266, -0.053) in the mediation analysis.
This study showed that bariatric surgery significantly reduced fat deposition and improved cognitive function in patients with obesity. Importantly, the improvement in brain functional activation played a key role in alleviating cognitive impairment, underscoring its vital importance in cognitive health.
有证据表明肥胖患者存在认知障碍和脑损伤。减肥手术是治疗肥胖的有效干预措施，且与认知功能改善有关。然而，减肥手术改善认知功能的潜在机制仍不清楚。本研究旨在评估减肥手术前后肥胖患者的认知改变，并进一步探讨脂肪减少、认知改变和潜在脑变化之间的关联。
我们对23例接受减肥手术的肥胖患者进行了一项探索性研究。这些患者在基线和术后12个月接受人体测量、详细的认知评估和功能磁共振成像（fMRI）扫描，以评估神经影像学和认知变化。
与基线相比，肥胖患者在减肥手术后即时和延迟记忆方面有显著改善。fMRI扫描还显示，肥胖患者术后左侧海马体积增加，右侧海马激活增强。此外，在中介分析中，这些认知功能和海马激活的改善与内脏脂肪（β = -0.122，95%自抽样CI：-0.210，-0.030）和肝脂肪变性（β = -0.147，95%自抽样CI：-0.266，-0.053）的减少有关。
本研究表明，减肥手术显著减少了肥胖患者的脂肪沉积并改善了认知功能。重要的是，脑功能激活的改善在减轻认知障碍中起关键作用，强调了其在认知健康中的至关重要性。
