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Development of dementia in patients who underwent bariatric surgery

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Abstract

Background

Dementia, including Alzheimer’s disease, interfere with daily function and are one of the major causes of disability, institutionalization, and death. Obesity is associated with an increased risk of dementia. However, the effect of significant and sustained weight loss following bariatric surgery on dementia is not known. The purpose of this study was to assess the long-term risk of dementia following bariatric surgery.

Methods

A surgical cohort was identified from the Utah Bariatric Surgery Registry and was linked to the Utah Population Database that includes electronic medical records, death records, and State Facility data. Adult subjects (≥ 18 years old) at time of surgery (1996–2016) were matched with non-surgical subjects. The final sample included 51,078 subjects (1:2 matching); surgery group n = 17,026; non-surgery subjects n = 34,052). Dementia were identified by ICD-9/10 diagnosis codes following surgery year or matched baseline year. Cox proportional hazard model was used to calculate the hazard ratio in the outcome between the groups.

Results

Average (SD) age of the subjects was 42 (12) years old at surgery or matched baseline year, 78% were female and mean follow-up time was 10.5 years. 1.4% of the surgery group and 0.5% of the control group had an incidence of dementia. Controlling the covariates in the Cox regression, the surgery group had a higher risk for dementia incidence than the matched non-surgery subjects (HR = 1.33, p = 0.02).

Conclusions

The study showed an increased hazard for dementia in individuals who underwent bariatric surgery compared to matched non-surgical subjects. Additional long-term data is needed to verify this association.

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References

  1. World Health Organization. Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

  2. Stanek KM, Gunstad J (2013) Can bariatric surgery reduce risk of Alzheimer’s disease? Prog Neuropsychopharmacol Biol Psychiatry 47:135–139

    Article  PubMed  Google Scholar 

  3. Whitmer RA, Gunderson EP, Barrett-Connor E, Quesenberry CP Jr, Yaffe K (2005) Obesity in middle age and future risk of dementia: a 27 year longitudinal population based study. BMJ 330:1360

    Article  PubMed  PubMed Central  Google Scholar 

  4. Gustafson D, Rothenberg E, Blennow K, Steen B, Skoog I (2003) An 18-year follow-up of overweight and risk of Alzheimer disease. Arch Intern Med 163:1524–1528

    Article  PubMed  Google Scholar 

  5. Profenno LA, Porsteinsson AP, Faraone SV (2010) Meta-analysis of Alzheimer’s disease risk with obesity, diabetes, and related disorders. Biol Psychiatry 67:505–512

    Article  PubMed  Google Scholar 

  6. Handley JD, Williams DM, Caplin S, Stephens JW, Barry J (2016) Changes in cognitive function following bariatric surgery: a systematic review. Obes Surg 26:2530–2537

    Article  PubMed  Google Scholar 

  7. Ghanim H, Monte SV, Sia CL, Abuaysheh S, Green K, Caruana JA, Dandona P (2012) Reduction in inflammation and the expression of amyloid precursor protein and other proteins related to Alzheimer’s disease following gastric bypass surgery. J Clin Endocrinol Metab 97:E1197-1201

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Nota MHC, Vreeken D, Wiesmann M, Aarts EO, Hazebroek EJ, Kiliaan AJ (2020) Obesity affects brain structure and function- rescue by bariatric surgery? Neurosci Biobehav Rev 108:646–657

    Article  PubMed  Google Scholar 

  9. Fratiglioni L, Mangialasche F, Qiu C (2010) Brain aging: lessons from community studies. Nutr Rev 68(Suppl 2):S119-127

    Article  PubMed  Google Scholar 

  10. Geldmacher DS, Whitehouse PJ (1996) Evaluation of dementia. N Engl J Med 335:330–336

    Article  CAS  PubMed  Google Scholar 

  11. Byers AL, Yaffe K (2011) Depression and risk of developing dementia. Nat Rev Neurol 7:323–331

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Plassman BL, Langa KM, Fisher GG, Heeringa SG, Weir DR, Ofstedal MB, Burke JR, Hurd MD, Potter GG, Rodgers WL, Steffens DC, Willis RJ, Wallace RB (2007) Prevalence of dementia in the United States: the aging, demographics, and memory study. Neuroepidemiology 29:125–132

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Matthews KA, Xu W, Gaglioti AH, Holt JB, Croft JB, Mack D, McGuire LC (2019) Racial and ethnic estimates of Alzheimer’s disease and related dementias in the United States (2015–2060) in adults aged >/=65 years. Alzheimers Dement 15:17–24

    Article  PubMed  Google Scholar 

  14. Sjostrom L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, Dahlgren S, Larsson B, Narbro K, Sjostrom CD, Sullivan M, Wedel H, Swedish Obese Subjects Study Scientific G (2004) Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 351:2683–2693

    Article  PubMed  Google Scholar 

  15. Adams TD, Davidson LE, Litwin SE, Kim J, Kolotkin RL, Nanjee MN, Gutierrez JM, Frogley SJ, Ibele AR, Brinton EA, Hopkins PN, McKinlay R, Simper SC, Hunt SC (2017) Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med 377:1143–1155

    Article  PubMed  PubMed Central  Google Scholar 

  16. Gunstad J, Strain G, Devlin MJ, Wing R, Cohen RA, Paul RH, Crosby RD, Mitchell JE (2011) Improved memory function 12 weeks after bariatric surgery. Surg Obes Relat Dis 7:465–472

    Article  PubMed  Google Scholar 

  17. Miller LA, Crosby RD, Galioto R, Strain G, Devlin MJ, Wing R, Cohen RA, Paul RH, Mitchell JE, Gunstad J (2013) Bariatric surgery patients exhibit improved memory function 12 months postoperatively. Obes Surg 23:1527–1535

    Article  PubMed  PubMed Central  Google Scholar 

  18. Alosco ML, Spitznagel MB, Strain G, Devlin M, Cohen R, Paul R, Crosby RD, Mitchell JE, Gunstad J (2014) Improved memory function two years after bariatric surgery. Obesity (Silver Spring) 22:32–38

    Article  PubMed  Google Scholar 

  19. Saindane AM, Drane DL, Singh A, Wu J, Qiu D (2020) Neuroimaging correlates of cognitive changes after bariatric surgery. Surg Obes Relat Dis 16:119–127

    Article  PubMed  Google Scholar 

  20. Armstrong RA (2019) Risk factors for Alzheimer’s disease. Folia Neuropathol 57:87–105

    Article  Google Scholar 

  21. Keshava HB, Mowla A, Heinberg LJ, Schauer PR, Brethauer SA, Aminian A (2017) Bariatric surgery may reduce the risk of Alzheimer’s diseases through GLP-1 mediated neuroprotective effects. Med Hypotheses 104:4–9

    Article  CAS  PubMed  Google Scholar 

  22. Al Mansoori A, Shakoor H, Ali HI, Feehan J, Al Dhaheri AS, Cheikh Ismail L, Bosevski M, Apostolopoulos V, Stojanovska L (2021) The effects of bariatric surgery on Vitamin B status and mental health. Nutrients 13(4):1383

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Centers for Medicare and Medicaid Services. Chronic Conditions Data Warehouse. https://www2.ccwdata.org/web/guest/condition-categories

  24. Thereaux J, Lesuffleur T, Czernichow S, Basdevant A, Msika S, Nocca D, Millat B, Fagot-Campagna A (2019) Long-term adverse events after sleeve gastrectomy or gastric bypass: a 7-year nationwide, observational, population-based, cohort study. Lancet Diabetes Endocrinol 7:786–795

    Article  PubMed  Google Scholar 

  25. McCaddon A, Regland B, Hudson P, Davies G (2002) Functional vitamin B(12) deficiency and Alzheimer disease. Neurology 58:1395–1399

    Article  CAS  PubMed  Google Scholar 

  26. Chai B, Gao F, Wu R, Dong T, Gu C, Lin Q, Zhang Y (2019) Vitamin D deficiency as a risk factor for dementia and Alzheimer’s disease: an updated meta-analysis. BMC Neurol 19:284

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Gibson GE, Hirsch JA, Fonzetti P, Jordan BD, Cirio RT, Elder J (2016) Vitamin B1 (thiamine) and dementia. Ann N Y Acad Sci 1367:21–30

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Zilkens RR, Bruce DG, Duke J, Spilsbury K, Semmens JB (2014) Severe psychiatric disorders in mid-life and risk of dementia in late- life (age 65–84 years): a population based case-control study. Curr Alzheimer Res 11:681–693

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Barnes DE, Yaffe K, Byers AL, McCormick M, Schaefer C, Whitmer RA (2012) Midlife vs late-life depressive symptoms and risk of dementia: differential effects for Alzheimer disease and vascular dementia. Arch Gen Psychiatry 69:493–498

    Article  PubMed  PubMed Central  Google Scholar 

  30. Harwood DG, Kalechstein A, Barker WW, Strauman S, St George-Hyslop P, Iglesias C, Loewenstein D, Duara R (2010) The effect of alcohol and tobacco consumption, and apolipoprotein E genotype, on the age of onset in Alzheimer’s disease. Int J Geriatr Psychiatry 25:511–518

    Article  PubMed  Google Scholar 

  31. Austin PC (2009) Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med 28:3083–3107

    Article  PubMed  PubMed Central  Google Scholar 

  32. Elze MC, Gregson J, Baber U, Williamson E, Sartori S, Mehran R, Nichols M, Stone GW, Pocock SJ (2017) Comparison of propensity score methods and covariate adjustment: evaluation in 4 cardiovascular studies. J Am Coll Cardiol 69:345–357

    Article  PubMed  Google Scholar 

  33. Jin S, Boehmke FJ (2017) Proper specification of nonproportional hazards corrections in duration models. Polit Anal 25:138–144

    Article  Google Scholar 

  34. Howard R, Chao GF, Yang J, Thumma J, Chhabra K, Arterburn DE, Ryan A, Telem DA, Dimick JB (2021) Comparative safety of sleeve gastrectomy and gastric bypass up to 5 years after surgery in patients with severe obesity. JAMA Surg. https://doi.org/10.1097/SLA.0000000000005692

    Article  PubMed  PubMed Central  Google Scholar 

  35. Gao S, Nguyen JT, Hendrie HC, Unverzagt FW, Hake A, Smith-Gamble V, Hall K (2011) Accelerated weight loss and incident dementia in an elderly African–American cohort. J Am Geriatr Soc 59:18–25

    Article  PubMed  Google Scholar 

  36. Buchman AS, Wilson RS, Bienias JL, Shah RC, Evans DA, Bennett DA (2005) Change in body mass index and risk of incident Alzheimer disease. Neurology 65:892–897

    Article  CAS  PubMed  Google Scholar 

  37. Salerno-Kennedy R, Cashman KD (2005) Relationship between dementia and nutrition-related factors and disorders: an overview. Int J Vitam Nutr Res 75:83–95

    Article  CAS  PubMed  Google Scholar 

  38. Antoniewicz A, Kalinowski P, Kotulecka KJ, Kocon P, Paluszkiewicz R, Remiszewski P, Zieniewicz K (2019) Nutritional deficiencies in patients after Roux-en-Y gastric bypass and sleeve gastrectomy during 12-month follow-up. Obes Surg 29:3277–3284

    Article  PubMed  Google Scholar 

  39. Bal BS, Finelli FC, Shope TR, Koch TR (2012) Nutritional deficiencies after bariatric surgery. Nat Rev Endocrinol 8:544–556

    Article  CAS  PubMed  Google Scholar 

  40. Rhode BM, Arseneau P, Cooper BA, Katz M, Gilfix BM, MacLean LD (1996) Vitamin B-12 deficiency after gastric surgery for obesity. Am J Clin Nutr 63:103–109

    Article  CAS  PubMed  Google Scholar 

  41. Punchai S, Hanipah ZN, Meister KM, Schauer PR, Brethauer SA, Aminian A (2017) Neurologic manifestations of Vitamin B deficiency after bariatric surgery. Obes Surg 27:2079–2082

    Article  PubMed  Google Scholar 

  42. Casimiro I, Sam S, Brady MJ (2019) Endocrine implications of bariatric surgery: a review on the intersection between incretins, bone, and sex hormones. Physiol Rep 7:e14111

    Article  PubMed  PubMed Central  Google Scholar 

  43. Dimitriadis E, Daskalakis M, Kampa M, Peppe A, Papadakis JA, Melissas J (2013) Alterations in gut hormones after laparoscopic sleeve gastrectomy: a prospective clinical and laboratory investigational study. Ann Surg 257:647–654

    Article  PubMed  Google Scholar 

  44. Sarwer DB, Spitzer JC, Wadden TA, Mitchell JE, Lancaster K, Courcoulas A, Gourash W, Rosen RC, Christian NJ (2014) Changes in sexual functioning and sex hormone levels in women following bariatric surgery. JAMA Surg 149:26–33

    Article  PubMed  Google Scholar 

  45. Janicki SC, Schupf N (2010) Hormonal influences on cognition and risk for Alzheimer’s disease. Curr Neurol Neurosci Rep 10:359–366

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Paganini-Hill A, Henderson VW (1994) Estrogen deficiency and risk of Alzheimer’s disease in women. Am J Epidemiol 140:256–261

    Article  CAS  PubMed  Google Scholar 

  47. Yildirim Simsir I, Soyaltin UE, Cetinkalp S (2018) Glucagon like peptide-1 (GLP-1) likes Alzheimer’s disease. Diabetes Metab Syndr 12:469–475

    Article  PubMed  Google Scholar 

  48. Onyike CU (2016) Psychiatric aspects of dementia. Continuum (Minneap Minn) 22:600–614

    PubMed  Google Scholar 

  49. Mitchell JE, Selzer F, Kalarchian MA, Devlin MJ, Strain GW, Elder KA, Marcus MD, Wonderlich S, Christian NJ, Yanovski SZ (2012) Psychopathology before surgery in the longitudinal assessment of bariatric surgery-3 (LABS-3) psychosocial study. Surg Obes Relat Dis 8:533–541

    Article  PubMed  PubMed Central  Google Scholar 

  50. Kalarchian MA, Marcus MD, Levine MD, Courcoulas AP, Pilkonis PA, Ringham RM, Soulakova JN, Weissfeld LA, Rofey DL (2007) Psychiatric disorders among bariatric surgery candidates: relationship to obesity and functional health status. Am J Psychiatry 164:328–334

    Article  PubMed  Google Scholar 

  51. Utah Department of Health (2017) Utah’s state plan for Alzheimer’s disease and related dementias 2018–2022. In: Health UDo (ed) Version 1.0., Salt Lake City, Utah. https://www.alz.org/media/documents/alzheimers-dementia-utah-state-plan-2018.pdf

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Funding

Partial support for all datasets within the Utah Population Database was provided by the University of Utah Huntsman Cancer Institute and the Huntsman Cancer Institute Cancer Center Support grant (grant number P30 CA2014) from the National Cancer Institute.

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Authors and Affiliations

  1. Department of Physical Therapy, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA

    Jaewhan Kim & Joshua Kelley

  2. Department of Psychiatry, University of Utah, 501 Chipeta Way, Salt Lake City, UT, 84108, USA

    Kristi Kleinschmit

  3. Intermountain Health Care, 5300 South State Street, Murray, UT, 84107, USA

    Nathan Richards

  4. Division of Epidemiology, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA

    Ted Adams

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Correspondence to Jaewhan Kim.

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Disclosures

Ted Adams has received research funding from NIH-NIDDK; Ethicon Endo-Surgery; and Intermountain Medical Research and Education Foundation, Intermountain Healthcare. Jaewhan Kim, Joshua Kelley, Kristi Kleinschmit, and Nathan Richards have no conflicts of interest or financial ties to disclose.

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Kim, J., Kelley, J., Kleinschmit, K. et al. Development of dementia in patients who underwent bariatric surgery. Surg Endosc 37, 3507–3521 (2023). https://doi.org/10.1007/s00464-022-09837-z

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