Short-term improvements in cognitive function following vertical sleeve gastrectomy and Roux-en Y gastric bypass: a direct comparison study

  • Kimberly R. SmithEmail author
  • Timothy H. Moran
  • Afroditi Papantoni
  • Caroline Speck
  • Arnold Bakker
  • Vidyulata Kamath
  • Susan Carnell
  • Kimberley E. Steele
2019 SAGES Oral



Cognitive deficits are observed in individuals with obesity. While bariatric surgery can reverse these deficits, it remains unclear whether surgery type differentially influences cognitive outcome. We compared the extent to which vertical sleeve gastrectomy (VSG) and Roux-en Y gastric bypass (RYGB) ameliorated cognitive impairments associated with obesity.


Female participants approved for VSG (N = 18) or RYGB (N = 18) were administered cognitive measures spanning the domains of attention [Hopkins Verbal Learning Test (HVLT) Trial 1 and Letter Number Sequencing], processing speed [Stroop Color Trial, Symbol Digit Modalities Test, and Trail Making Part A], memory [HVLT Retained and HVLT Discrimination Index], and executive functioning (Stroop Color Word Trials and Trail Making Part B–A) prior to surgery and at 2 weeks and 3 months following surgery. Scores for each cognitive domain were calculated and compared between surgical cohorts using repeated measures analyses of variance.


Significant weight loss was observed 2 weeks and 3 months following RYGB and VSG and was accompanied by improvements in processing speed and executive functioning. Patients who received RYGB also experienced improved attention as early as 2 weeks, which persisted at 3 months. This was not observed in individuals who underwent VSG. No changes in memory were observed from baseline measures in either group.


This is the first report of cognitive improvements following VSG and the first direct comparison of cognitive improvements following RYGB and VSG. Short-term improvements in specific domains of cognitive function are observed at the beginning of the active weight loss phase following bariatric surgery that persisted to 3 months. The anatomical distinction between the two surgeries and resulting differential metabolic profiles may be responsible for the improvements in attention observed following RYGB but not following VSG.


Bariatric surgery Vertical sleeve gastrectomy Roux-en Y gastric bypass Cognition 



The authors would like to thank Civonnia Harris for her role in data collection. Funding for this research was provided by 1K23DK100559 from the National Institutes of Health to K.E.S. and The Dalio Foundation.


1K23DK100559 to K.E.S. and The Dalio Foundation.

Compliance with ethical standards


Kimberly R. Smith, Timothy H. Moran, Afroditi Papantoni, Caroline Speck, Arnold Bakker, Vidyulata Kamath, Susan Carnell, and Kimberley E. Steele have no conflicts of interest and financial ties to disclose.


  1. 1.
    Cournot M, Marquié JC, Ansiau D et al (2006) Relation between body mass index and cognitive function in healthy middle-aged men and women. Neurology 67(7):1208–1214PubMedCrossRefGoogle Scholar
  2. 2.
    Gunstad J, Lhotsky A, Wendell CR, Ferrucci L, Zonderman AB (2010) Longitudinal examination of obesity and cognitive function: Results from the baltimore longitudinal study of aging. Neuroepidemiology 34(4):222–229PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Fergenbaum JH, Bruce S, Lou W, Hanley AJG, Greenwood C, Young TK (2009) Obesity and lowered cognitive performance in a canadian first nations population. Obesity 17(10):1957–1963PubMedCrossRefGoogle Scholar
  4. 4.
    Kollei I, Rustemeier M, Schroeder S, Jongen S, Herpertz S, Loeber S (2018) Cognitive control functions in individuals with obesity with and without binge-eating disorder. Int J Eat Disord 51(3):233–240PubMedCrossRefGoogle Scholar
  5. 5.
    Galioto R, Spitznagel MB, Strain G et al (2012) Cognitive function in morbidly obese individuals with and without binge eating disorder. Compr Psychiatry 53(5):490–495PubMedCrossRefGoogle Scholar
  6. 6.
    Sellbom KS, Gunstad J (2012) Cognitive function and decline in obesity. J Alzheimer’s Dis 30(s2):S95Google Scholar
  7. 7.
    Prickett C, Brennan L, Stolwyk R (2015) Examining the relationship between obesity and cognitive function: a systematic literature review. Obes Res Clin Pract 9(2):93–113PubMedCrossRefGoogle Scholar
  8. 8.
    ASMBS. Estimate of bariatric surgery numbers, 2011–2017. Updated 2018
  9. 9.
    Handley JD, Williams DM, Caplin S, Stephens JW, Barry J (2016) Changes in cognitive function following bariatric surgery: a systematic review. Obes Surg 26(10):2530–2537PubMedCrossRefGoogle Scholar
  10. 10.
    Alosco ML, Galioto R, Spitznagel MB et al (2014) Cognitive function following bariatric surgery: evidence for improvement 3 years post-surgery. Am J Surg 207(6):870–876PubMedCrossRefGoogle Scholar
  11. 11.
    Marques EL, Halpern A, Corrêa Mancini M et al (2014) Changes in neuropsychological tests and brain metabolism after bariatric surgery. J Clin Endocrinol Metab 99(11):2347CrossRefGoogle Scholar
  12. 12.
    Alosco ML, Spitznagel MB, Strain G et al (2014) Improved memory function two years after bariatric surgery. Obesity 22(1):32–38PubMedCrossRefGoogle Scholar
  13. 13.
    Lavender JM, Alosco ML, Spitznagel MB et al (2014) Association between binge eating disorder and changes in cognitive functioning following bariatric surgery. J Psychiatr Res 59:148–154PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Yousseif A, Emmanuel J, Karra E et al (2014) Differential effects of laparoscopic sleeve gastrectomy and laparoscopic gastric bypass on appetite, circulating acyl-ghrelin, peptide YY3-36 and active GLP-1 levels in non-diabetic humans. Obes Surg 24(2):241–252PubMedCrossRefGoogle Scholar
  15. 15.
    Peterli R, Wölnerhanssen B, Peters T et al (2009) Improvement in glucose metabolism after bariatric surgery: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a prospective randomized trial. Ann Surg 250(2):234–241PubMedCrossRefGoogle Scholar
  16. 16.
    Pucci A, Batterham R (2019) Mechanisms underlying the weight loss effects of RYGB and SG: similar, yet different. J Endocrinol Invest 42(2):117–128PubMedCrossRefGoogle Scholar
  17. 17.
    Kanoski SE, Fortin SM, Ricks KM, Grill HJ (2013) Ghrelin signaling in the ventral hippocampus stimulates learned and motivational aspects of feeding via PI3 K-akt signaling. Biol Psychiatry 73(9):915–923PubMedCrossRefGoogle Scholar
  18. 18.
    Zhao Z, Liu H, Xiao K et al (2014) Ghrelin administration enhances neurogenesis but impairs spatial learning and memory in adult mice. Neuroscience 257:175–185PubMedCrossRefGoogle Scholar
  19. 19.
    During MJ, Cao L, Zuzga DS et al (2003) Glucagon-like peptide-1 receptor is involved in learning and neuroprotection. Nat Med 9(9):1173–1179PubMedCrossRefGoogle Scholar
  20. 20.
    Atcha Z, Chen W, Ong AB et al (2009) Cognitive enhancing effects of ghrelin receptor agonists. Psychopharmacology 206(3):415–427PubMedCrossRefGoogle Scholar
  21. 21.
    Li E, Kim Y, Kim S, Park S (2013) Ghrelin-induced hippocampal neurogenesis and enhancement of cognitive function are mediated independently of GH/IGF-1 axis: lessons from the spontaneous dwarf rats. Endocr J 60(9):1065–1075PubMedCrossRefGoogle Scholar
  22. 22.
    Wechsler D. WMS-R: Wechsler memory scale–revised: Manual. San Antonio: Psychological Corporation: Harcourt Brace Jovanovich; 1987Google Scholar
  23. 23.
    Brandt J (1991) The hopkins verbal learning test: development of a new memory test with six equivalent forms. Clin Neuropsychol 5(2):125–142CrossRefGoogle Scholar
  24. 24.
    Golden CJ (1978) Stroop color and word test: a manual for clinical and experimental uses. Stoelting Co., ChicagoGoogle Scholar
  25. 25.
    Smith A (1982) Symbol digit modalities test (SDMT). manual (revised). Western Psychological Services, TorranceGoogle Scholar
  26. 26.
    Tombaugh TN (2004) Trail making test A and B: normative data stratified by age and education. Arch Clin Neuropsychol 19(2):203–214PubMedCrossRefGoogle Scholar
  27. 27.
    Gunstad J, Strain G, Devlin MJ et al (2011) Improved memory function 12 weeks after bariatric surgery. Surg Obes Relat Dis 7(4):465–472PubMedCrossRefGoogle Scholar
  28. 28.
    Veronese N, Facchini S, Stubbs B et al (2017) Weight loss is associated with improvements in cognitive function among overweight and obese people: a systematic review and meta-analysis. Neurosci Biobehav Rev 72:87–94PubMedCrossRefGoogle Scholar
  29. 29.
    Richette P, Poitou C, Garnero P et al (2011) Benefits of massive weight loss on symptoms, systemic inflammation and cartilage turnover in obese patients with knee osteoarthritis. Ann Rheum Dis 70(1):139–144PubMedCrossRefGoogle Scholar
  30. 30.
    Blum A, Tamir S, Hazzan D et al (2012) Gender effect on vascular inflammation following bariatric surgery. Eur Cytokine Netw 23(4):154–157PubMedGoogle Scholar
  31. 31.
    Netto BDM, Bettini SC, Clemente APG et al (2015) Roux-en-Y gastric bypass decreases pro-inflammatory and thrombotic biomarkers in individuals with extreme obesity. Obes Surg 25(6):1010–1018PubMedCrossRefGoogle Scholar
  32. 32.
    Carbone F, Nulli Migliola E, Bonaventura A et al (2018) High serum levels of C-reactive protein (CRP) predict beneficial decrease of visceral fat in obese females after sleeve gastrectomy. Nutr Metab Cardiovasc Dis 28(5):494–500PubMedCrossRefGoogle Scholar
  33. 33.
    van de Weijgert EJ, Ruseler CH, Elte JW (1999) Long-term follow-up after gastric surgery for morbid obesity: preoperative weight loss improves the long-term control of morbid obesity after vertical banded gastroplasty. Obes Surg 9(5):426–432PubMedCrossRefGoogle Scholar
  34. 34.
    Pories WJ, Swanson MS, MacDonald KG et al (1995) Who would have thought it? an operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 222(3):352CrossRefGoogle Scholar
  35. 35.
    MacDonald KG, Long SD, Swanson et al (1997) The gastric bypass operation reduces the progression and mortality of non-insulin-dependent diabetes mellitus. J Gastrointest Surg 1(3):213–220PubMedCrossRefGoogle Scholar
  36. 36.
    Sjöström L, Lindroos A, Peltonen M et al (2004) Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 351(26):2683–2693PubMedCrossRefGoogle Scholar
  37. 37.
    Karmali S, Brar B, Shi X, Sharma AM, de Gara C, Birch DW (2013) Weight recidivism post-bariatric surgery: a systematic review. Obes Surg 23(11):1922–1933PubMedCrossRefGoogle Scholar
  38. 38.
    Dar MS, Chapman WH, Pender JR et al (2012) GLP-1 response to a mixed meal: what happens 10 years after Roux-en-Y gastric bypass (RYGB)? Obes Surg 22(7):1077–1083PubMedCrossRefGoogle Scholar
  39. 39.
    Ryan L, Walther K (2014) White matter integrity in older females is altered by increased body fat. Obesity 22(9):2039–2046PubMedCrossRefGoogle Scholar
  40. 40.
    Mueller K, Anwander A, Möller HE et al (2011) Sex-dependent influences of obesity on cerebral white matter investigated by diffusion-tensor imaging. PLoS ONE 6(4):e18544PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Karlsson HK, Tuulari JJ, Hirvonen J et al (2013) Obesity is associated with white matter atrophy: a combined diffusion tensor imaging and voxel-based morphometric study. Obesity 21(12):2530–2537PubMedCrossRefGoogle Scholar
  42. 42.
    Kullmann S, Heni M, Veit R et al (2012) The obese brain: association of body mass index and insulin sensitivity with resting state network functional connectivity. Hum Brain Mapp 33(5):1052–1061PubMedCrossRefGoogle Scholar
  43. 43.
    Stanek KM, Grieve SM, Brickman AM et al (2011) Obesity is associated with reduced white matter integrity in otherwise healthy adults. Obesity 19(3):500–504PubMedCrossRefGoogle Scholar
  44. 44.
    Verstynen TD, Weinstein A, Erickson KI, Sheu LK, Marsland AL, Gianaros PJ (2013) Competing physiological pathways link individual differences in weight and abdominal adiposity to white matter microstructure. Neuroimage 79:129–137PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Zhang R, Beyer F, Lampe L et al (2018) White matter microstructural variability mediates the relation between obesity and cognition in healthy adults. Neuroimage 172:239–249PubMedCrossRefGoogle Scholar
  46. 46.
    Cherbuin N, Sargent-Cox K, Fraser M, Sachdev P, Anstey KJ (2015) Being overweight is associated with hippocampal atrophy: the PATH through life study. Int J Obes 39(10):1509–1514CrossRefGoogle Scholar
  47. 47.
    Zhang Y, Ji G, Xu M et al (2016) Recovery of brain structural abnormalities in morbidly obese patients after bariatric surgery. Int J Obes 40(10):1558–1565CrossRefGoogle Scholar
  48. 48.
    Liu L, Ji G, Li G et al (2018) Structural changes in brain regions involved in executive-control and self-referential processing after sleeve gastrectomy in obese patients. Brain Imaging Behav. 13(3):830–840CrossRefGoogle Scholar
  49. 49.
    Rullmann M, Preusser S, Poppitz S et al (2018) Gastric-bypass surgery induced widespread neural plasticity of the obese human brain. Neuroimage 172:853–863PubMedCrossRefGoogle Scholar
  50. 50.
    Karamanakos SN, Vagenas K, Kalfarentzos F, Alexandrides TK (2008) Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg 247(3):401–407PubMedCrossRefGoogle Scholar
  51. 51.
    Kalinowski P, Paluszkiewicz R, Wróblewski T et al (2017) Ghrelin, leptin, and glycemic control after sleeve gastrectomy versus Roux-en-Y gastric bypass-results of a randomized clinical trial. Surg Obes Relat Dis 13(2):181–188PubMedCrossRefGoogle Scholar
  52. 52.
    Cummings DE, Weigle DS, Frayo RS et al (2002) Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med 346(21):1623–1630PubMedCrossRefGoogle Scholar
  53. 53.
    Faraj M, Havel PJ, Phélis S, Blank D, Sniderman AD, Cianflone K (2003) Plasma acylation-stimulating protein, adiponectin, leptin, and ghrelin before and after weight loss induced by gastric bypass surgery in morbidly obese subjects. J Clin Endocrinol Metab 88(4):1594–1602PubMedCrossRefGoogle Scholar
  54. 54.
    Frühbeck G, Rotellar F, Hernández-Lizoain JL et al (2004) Fasting plasma ghrelin concentrations 6 months after gastric bypass are not determined by weight loss or changes in insulinemia. Obes Surg 14(9):1208–1215PubMedCrossRefGoogle Scholar
  55. 55.
    Xu H, Pang Y, Chen J et al (2019) Systematic review and meta-analysis of the change in ghrelin levels after Roux-en-Y gastric bypass. Obes Surg 29(4):1343–1351PubMedCrossRefGoogle Scholar
  56. 56.
    Spitznagel MB, Benitez A, Updegraff J et al (2010) Serum ghrelin is inversely associated with cognitive function in a sample of non-demented elderly. Psychiatry Clin Neurosci 64(6):608–611PubMedCrossRefGoogle Scholar
  57. 57.
    Kunath N, Müller NCJ, Tonon M et al (2016) Ghrelin modulates encoding-related brain function without enhancing memory formation in humans. Neuroimage 142:465–473PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Kimberly R. Smith
    • 1
    Email author
  • Timothy H. Moran
    • 1
  • Afroditi Papantoni
    • 1
  • Caroline Speck
    • 1
  • Arnold Bakker
    • 1
  • Vidyulata Kamath
    • 1
  • Susan Carnell
    • 1
  • Kimberley E. Steele
    • 2
    • 3
  1. 1.Department of Psychiatry & Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of SurgeryJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Department of Health, Behavior and SocietyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA

Personalised recommendations