| BackgroundObesity is one of the most challenging public health problems in the world today and is strongly associated with cognitive decline in addition to increasing the risk of diabetes,cardiovascular disease,stroke and certain cancers.In addition,obesity may lead to hypothalamic inflammation.Studies have suggested a possible causal link between hypothalamic inflammation caused by obesity and cognitive impairment.However,there is still a lack of sufficient clinical evidence for this association,and the characteristics of cognitive impairment of obesity-induced hypothalamic inflammation is controversial.ObjectiveThe purpose of this study was to assess the cognitive function of obese patients undergoing bariatric surgery and to investigate its relationship with hypothalamic inflammation to provide ideas for the protection and intervention of cognitive function and improvement of quality of life in obese patients.MethodsIn this study,76 obese patients undergoing bariatric surgery at the Second People’s Hospital of chang zhou between January 2019 and November 2021 were consecutively enrolled,and they were divided into obese and morbidly obese groups according to the World Health Organization Body Mass Index(BMI)grouping criteria,and non-obese patients hospitalized in the Department of Neurology during the same period The nonobese patients admitted to the neurology department at the same time were used as the normal weight control group.The age,sex,height,weight,education,lipids,calcitoninogen,fasting glucose,glycosylated hemoglobin and renal function of the patients were recorded,and the overall cognition and cognitive areas were measured separately.The overall cognitive scale included the Montreal Cognitive Assessment(MoCA);the cognitive regions were assessed,including attention/executive function(Digit Breadth Test,Stroop Color Word Test)and memory(Rey Word Learning Test).Mental status assessment included examination of the Self-Assessment Scale for Anxiety(SAS)and the Self-Reportation Scale for Depression(SDS).Hypothalamic inflammation was studied by the signal intensity ratio(SI)of the hypothalamus/amygdala(H/A)on MRI T2-weighted phase.Results1.The differences in BMI,low-density cholesterol,high-density cholesterol,and uric acid between the obese,morbidly obese,and normal groups were statistically significant(P < 0.05).And there were no statistically significant differences in age,gender,education level of patients and fasting blood glucose,glycosylated hemoglobin,triglycerides,total cholesterol,creatinine and urea nitrogen between groups(P>0.05).2.The differences in MoCA scores and the cognitive impairment rate of MoCA scale between the three groups were statistically significant(P < 0.05),but further pairwise comparison of the obese and morbidly obese groups showed lower scores than the control group.There was no statistically significant difference in the numerical breadth test between groups and further pairwise comparisons among the three groups.There was no statistically significant comparison between the three groups in terms of B card use time and SIE elapsed time(P < 0.05),and further pairwise comparison between the obese group and the morbidly obese group.there was no statistically significant comparison between the groups in terms of A card use time,C card use time and SIE accuracy(P > 0.05),but further pairwise comparison,C card use time was statistically significant higher in the morbidly obese group than in the control group(P < 0.05).The immediate memory and delayed memory of REY auditory word test were statistically significant(P < 0.05)in the comparison between the three groups,and the immediate memory and delayed memory of the obese group and morbidly obese group were lower than those of the control group in the further pairwise comparison.In addition the incidence of anxiety and depression was significantly higher in the obese and morbid obese groups than in the control group(P < 0.05).3.The bilateral H/A signal intensity ratios of the obese,morbidly obese and normal groups were statistically significant(P < 0.001).In post hoc pairwise comparisons,the bilateral H/A signal intensity ratio was lower in both the obese and morbidly obese groups than in the control group(P < 0.05);the bilateral H/A signal intensity ratio was not statistically significant in the obese and morbidly obese groups(P > 0.05).In addition,the incidence of anxiety and depression in obesity group and morbid obesity group was significantly higher than that in control group(P < 0.05).4.Within the obese group,there was no significant correlation between the H/A signal intensity ratio of bilateral T2-weighted images and BMI,MoCA,digit span test,A-card time,C-card time,correct number of SIE,SIE time,immediate memory of REY auditory word test,delayed memory,and the score of depression self-rating scale(P>0.05).However,the right H/A signal intensity ratio was correlated with B-card time and the scole of anxiety self-rating scale(P < 0.05),the left H/A signal intensity ratio was correlated with the rate of MoCA cognitive impairment(P < 0.05).5.In the morbidly obese group,there was no significant correlation between the ratio of bilateral H/A signal intensity and BMI,MoCA,MoCA cognitive impairment rate,digit span test,A-card duration,correct number of SIE,SIE time consumption,REY auditory word test immediate memory,delayed memory,and self-rating anxiety scale(P>0.05).The left H/A signal intensity ratio was significantly correlated with the time of B card and C card(P < 0.05),the bilateral H/A signal intensity ratios were significantly correlated with self-rating depression scale(P < 0.05).Conclusion1.Obesity and morbid obesity patients have lower cognitive level than normal population.2.Obesity has a wide range of effects on patients’ cognitive impairment,with particularly significant effects on memory function and executive function.Obese and morbidly obese patients have obvious hypothalamic damage,suggesting bilateral gliosis and hypothalamic inflammation.3.There is a correlation between hypothalamic inflammation caused by obesity and cognitive function.4.Obesity and morbid obesity patients have a high incidence rate of anxiety and depression.Hypothalamic inflammation may be one of the links between obesity and anxiety and depression disorders. |
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