Cognitive improvement after bariatric surgery in obesity: neuronal correlates and underlying mechanisms

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Overweight and obesity are on the rise worldwide. These conditions are linked with severe co-morbidities including hypertension, disturbances in lipid metabolism, insulin resistance and type 2 diabetes mellitus, as well as sleep apnea, all of which have already been extensively studied in a number of studies. Currently, negative effects of overweight and obesity on brain function and structure become increasingly recognized. In the stage of morbid obesity, a conventional therapy aiming at weight loss is usually frustrating, so that bariatric surgery has proven to be a promising alter native. Here, food supply and ingestion is restricted by surgery on the gastrointestinal system, causing considerable loss of weight. First studies could show cognitive improvements after surgery, for example in word production and in memory formation. However, the impact of bariatric surgery , particularly restrictive vs restrictive and maladsorptive approaches, on brain function and structure remains incompletely understood. Effects at the neuronal level have not been studied (for example, changes in gray matter volume and functional and structural connectivity of individual brain regions such as the hippocampus; reward system). Also, the mechanisms underlying these improvements are unclear (for example, with regard to vascular changes, anti-inflammatory processes, insulin -glucose metabolism, or other hormones of the gastro-intestinal tract, immunological parameters, gut micorbiom). With the current project we aim to answer the following questions:1) Does bariatric surgery with a restrictive and maladsorptive approach, compared waiting list control group, improve cognitive performance? 2) Does this bariatric surgery lead to improvements in structure and connectivity of gray and white matter of the brain, and neural activity in response to neutral, high- and low-caloric stimuli? 3) Does this bariatric surgery induce improvements in blood pressure, energy and lipid metabolism, inflammatory processes, gastrointestinal hormones, immunological parameters, gut microbiom? Long-term sequelae of 1) to 3), and comparison with restrictive-only bariatric surgery?The answers to these research questions will provide an important contribution in the evaluation of bariatric surgery as a clinical treatment, as cognitive functions are critical for quality of life and social participation. Moreover, we will gain outstanding scientific insights into the mechanistic link between obesity and cognition.