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

超重和肥胖在世界范围内呈上升趋势。这些疾病与严重的合并症有关，包括高血压、脂质代谢紊乱、胰岛素抵抗和2型糖尿病以及睡眠呼吸暂停，所有这些都已在许多研究中得到广泛研究。目前，超重和肥胖对大脑功能和结构的负面影响越来越受到重视。在病态肥胖阶段，旨在减肥的常规疗法通常令人沮丧，因此减肥手术已被证明是一种有前途的替代疗法。在这里，食物供应和摄入受到胃肠道系统手术的限制，导致体重大幅下降。首先，研究可以显示手术后的认知改善，例如在单词产生和记忆形成方面。然而，减肥手术，特别是限制性与限制性和吸附不良的方法，对脑功能和结构的影响仍然不完全清楚。尚未研究神经元水平的影响（例如，灰质体积的变化以及海马体等单个大脑区域的功能和结构连接;奖励系统）。此外，这些改善的机制尚不清楚（例如，关于血管变化、抗炎过程、胰岛素-葡萄糖代谢或胃肠道的其他激素、免疫学参数、肠道微生物）。通过本项目，我们的目标是回答以下问题：1）与等待名单对照组相比，限制性和吸附不良的减肥手术是否能改善认知能力？2)这种减肥手术是否会改善大脑灰质和白色物质的结构和连通性，以及对中性、高热量和低热量刺激的神经活动？3)这种减肥手术是否会改善血压、能量和脂质代谢、炎症过程、胃肠道激素、免疫参数、肠道微生物？1）至3）的长期后遗症，以及与仅限制性减肥手术的比较？这些研究问题的答案将为减肥手术作为临床治疗的评价提供重要贡献，因为认知功能对生活质量和社会参与至关重要。此外，我们将获得关于肥胖和认知之间的机械联系的杰出科学见解。

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.