Cognitive Effects of Intentional Weight Loss in Elderly Obese Individuals With Mild Cognitive Impairment.

CONTEXT: Obesity in midlife is a risk factor for dementia, but it is unknown if caloric restriction-induced weight loss could prevent cognitive decline and therefore dementia in elderly patients with cognitive impairment. OBJECTIVE: To evaluate the cognitive effect of intentional weight loss in obese elderly patients with mild cognitive impairment (MCI), considering the influence of age, apolipoprotein E (APOE) genotype, physical activity, biochemical markers, and diet. DESIGN: Single-center, prospective controlled trial. SETTING: Academic medical center. PARTICIPANTS: Eighty obese patients with MCI, aged 60 or older (68.1 ± 4.9 y, body mass index [BMI] 35.5 ± 4.4 kg/m(2), 83.7% women, 26.3% APOE allele ϵ4 carriers). INTERVENTION: Random allocation to conventional medical care alone (n = 40) or together with nutritional counselling (n = 40) in group meetings aiming to promote weight loss through caloric restriction for 12 months. OUTCOME MEASUREMENTS: clinical data, body composition, neuropsychological tests (main outcome), serum biomarkers, APOE genotype, physical performance, dietary recalls. RESULTS: Seventy-five patients completed the follow-up. BMI, on average, decreased 1.7 ± 1.8 kg/m(2) (P = .021), and most of the cognitive tests improved, without difference between the groups. In analysis with linear generalized models, the BMI decrease was associated with improvements in verbal memory, verbal fluency, executive function, and global cognition, after adjustment for education, gender, physical activity, and baseline tests. This association was strongest in younger seniors (for memory and fluency) and in APOE allele ϵ4 carriers (for executive function). Changes in homeostasis model assessment-estimated insulin resistance, C-reactive protein, leptin and intake of energy, carbohydrates, and fats were associated with improvement in cognitive tests. CONCLUSIONS: Intentional weight loss through diet was associated with cognitive improvement in patients with MCI.

Changes in neuropsychological tests and brain metabolism after bariatric surgery.

CONTEXT: The mechanisms by which obesity alters the cerebral function and the effect of weight loss on the brain have not been completely clarified. OBJECTIVE: The objective of the study was to assess the effect of bariatric surgery on the cognitive function and cerebral metabolism. DESIGN: Seventeen obese women were studied prior to and 24 weeks after bariatric surgery using neuropsychological tests and positron emission tomography. SETTING: The study was conducted in a reference center for the treatment of obesity of a Brazilian public university. PARTICIPANTS: Thirty-three women paired by age and level of education made up two groups: 17 severely obese patients and 16 lean patients. They did not have diabetes mellitus or a family history of dementia. MAIN OUTCOME MEASURES: Comparison of performance in neuropsychological tests and cerebral metabolism of the obese women before and after bariatric surgery was measured. The results found at the two moments were compared with those of the women of normal weight. RESULTS: Women with a mean age of 40.5 years and mean body mass index of 50.1 kg/m(2) when compared with women with mean body mass index of 22.3 kg/m(2) showed increased cerebral metabolism, especially in the posterior cingulate gyrus (P < .004). No difference was found between the groups for the neuropsychological tests. After 24 weeks the cerebral metabolism of the obese women was lower, similar to the lean women, and there was an improvement of executive function, accompanying changes of metabolic and inflammatory parameters. CONCLUSIONS: Obese women may have increased cerebral metabolism when compared with women of normal weight, and this appears to reverse after weight loss induced by bariatric surgery, accompanied by improved executive function.

Prevalência de sintomas de ansiedade e depressão em pacientes com diferentes graus de obesidade / Prevalence of anxiety and depression symptoms in patients with different degrees of obesity

Introdução: A obesidade apresenta elevada prevalência e está associada ao aumento da morbidade e mortalidade. Vários estudos já identificaram impacto negativo da adiposidade em sintomas psicológicos, porém ainda se investiga a relação de causalidade entre estas afecções. Objetivo: Determinar a prevalência de sintomas ansiosos e depressivos em pacientes com diferentes graus de obesidade. Métodos: Estudo observacional transversal realizado entre 2016 e 2019 por meio da aplicação do questionário Escala Hospitalar de Ansiedade e Depressão (HADS) em pacientes com obesidade. Resultados: Foram incluídos 47 pacientes no estudo. 14 pacientes com obesidade grau 1 (G1) , 14 pacientes com obesidade grau 2 (G2) e 19 pacientes com obesidade grau 3 (G3). Do total, 37 eram mulheres (78,7%), com média de idade 43±10 anos, 110,6±27,7 kg e índice de massa corporal de 41,8±9,3 kg/m². Entre os participantes, 17 (36,2%) tinham sintomas de ansiedade, sendo 6 (42,9%) do G1, 6 (42,9%) do G2 e 5 (26,3%) do G3, (p=0,511). 16 pacientes (34%) tiveram sintomas depressivos, correspondendo a 5 (35,7%) pacientes no G1, 4 (28,6%) no G2 e 7 (36,8%) no G3, (p=0,874). Uma moderada correlação entre HADS-A e HADS-D foi constatada (r=0,654) (p<0,001). Conclusão: Foram identificadas elevadas taxas de sintomas ansiosos e depressivos entre os pacientes avaliados, dados estes, superiores aos dados da população geral descrito na literatura. Entretanto, não foram identificadas diferenças entre os diferentes graus de obesidade quanto a prevalência de sintomas ansiosos ou depressivos.

Introduction: Obesity has high prevalence and is associated with increased morbidity and mortality. Several studies have already identified negative impact of adiposity on psychological symptoms, but the causal relationship between these conditions is still investigated. Objective: To determine the prevalence of anxious and depressive symptoms in patients with different degrees of obesity. Methods: Cross-sectional observational study conducted between 2016 and 2019 by applying the questionnaire Hospital Anxiety and Depression Scale (HADS) in obese patients. Results: 47 patients were included in the study. 14 patients with grade 1 obesity (G1), 14 patients with grade 2 obesity (G2) and 19 patients with grade 3 obesity (G3). Of the total, 37 were women (78.7%), with a mean age of 43 ± 10 years, 110.6 ± 27.7 kg and body mass index of 41.8 ± 9.3 kg / m². Among the participants, 17 (36.2%) had anxiety symptoms, being 6 (42.9%) from G1, 6 (42.9%) from G2 and 5 (26.3%) from G3, (p = 0.511). 16 patients (34%) had depressive symptoms, corresponding to 5 (35.7%) patients in G1, 4 (28.6%) in G2 and 7 (36.8%) in G3, (p = 0.874). A moderate correlation between HADS-A and HADS-D was found (r = 0.654) (p <0.001). Conclusion: High rates of anxious and depressive symptoms were identified among the patients evaluated, which is higher than the general population data described in the literature. However, no differences were identified between the different degrees of obesity regarding the prevalence of anxious or depressive symptoms.

Efeito da perda de peso induzida por cirurgia bariátrica sobre metabolismo cerebral e função cognitiva / The effect of bariatric surgery induced weight loss on brain metabolism and cognitive function

INTRODUÇÃO: Obesidade e doença de Alzheimer afetam um número cada vez maior de pessoas no mundo. Nos últimos anos, surgiram várias evidências de que essas duas doenças estão interligadas, sendo obesidade um fator de risco para a ocorrência de demência. A doença de Alzheimer é de mau prognóstico e de difícil tratamento e estão envolvidos na sua patogênese fatores genéticos e ambientais. A obesidade é encarada como um fator ambiental modificável e, talvez, capaz de mudar a história natural da doença se precocemente controlada. A cirurgia bariátrica é o tratamento mais eficaz para obesidade severa; no entanto, não se sabe claramente o efeito da cirurgia bariátrica sobre o metabolismo cerebral e a função cognitiva. OBJETIVOS: Avaliar prospectivamente o impacto da perda de peso induzida pela cirurgia bariátrica sobre metabolismo cerebral e função cognitiva de obesos; correlacionar metabolismo cerebral e função cognitiva antes e após a cirurgia bariátrica com marcadores metabólicos e inflamatórios. MÉTODOS: 17 mulheres obesas realizaram tomografia computadorizada com emissão de pósitrons com flúor-desoxi-glicose (PET-FDG) para avaliação do metabolismo cerebral de repouso (metabolismo glicolítico regional), testes neuropsicológicos para avaliação da função cognitiva e dosagens de marcadores metabólicos e inflamatórios antes e após a cirurgia bariátrica e, foram comparadas com 16 mulheres de peso normal, eutróficas, pareadas em idade e escolaridade. Foram excluídas da seleção pacientes portadoras de diabetes, usuárias de medicação psicotrópica nos três meses que antecederam as avaliações, portadoras de doença psiquiátrica grave atual ou prévia e mulheres com história de pais acometidos por demência antes dos 70 anos de idade. Nas mulheres obesas as avaliações do metabolismo cerebral, da função cognitiva e das dosagens laboratoriais foram realizadas antes e aproximadamente seis meses após a cirurgia bariátrica, enquanto nas mulheres eutróficas foram realizadas...

INTRODUCTION: Obesity and Alzheimer's disease affect a growing number of people in the world. In recent years, evidence has arisen suggesting that these two illnesses are linked, with obesity being a risk factor for the occurrence of dementia. Alzheimer's disease has an unfavorable prognosis, is hard to treat and genetic and environmental factors are involved in the pathogenesis. Obesity is regarded as a modifiable environmental factor and maybe capable of changing the natural prognosis of the disease if controlled at an early stage. Bariatric surgery is the most effective treatment for severe obesity, however the effect of bariatric surgery on cerebral metabolism and cognitive function is not clearly known. OBJECTIVES: Prospectively assess the impact of weight loss caused by bariatric surgery on the cerebral metabolism and cognitive function of the obese. Correlate the cerebral metabolism and cognitive function before and after bariatric surgery with metabolic and inflammatory markers. METHODS: 17 obese women performed computerized positron emission tomography with fluoro-deoxy-glucose (FDG-PET) for the assessment of resting cerebral metabolism (regional glycolytic metabolism), neuropsychological tests to assess cognitive function and doses of metabolic and inflammatory markers before and after bariatric surgery and compared with 16 women of normal weight, eutrophic, paired by age and level of education. Patients with diabetes, those who had used psychotropic medication within three months prior to the assessments, people with current or previous history of severe psychiatric illness and women with a family history of dementia before 70 years of age. The assessments of cerebral metabolism, cognitive function and laboratory doses were conducted before and approximately 6 months after bariatric surgery in the obese women, whereas the women of normal weight were only assessed once. The imaging data was processed using the Statistic Parametric Mapping (SPM)...