title: Bariatric surgery in the cognitively impaired.
abstract: BACKGROUND
  Obesity is prevalent in patients with cognitive impairment, but the risks and benefits in this complex group are unknown.
  
  
  OBJECTIVE
  The aim of this study was to assess outcomes in a small cohort of patients with lifelong cognitive impairment who underwent bariatric surgery and to introduce important concepts when considering surgery in this complex group.
  
  
  METHODS
  Academic institution, United States.
  
  
  METHODS
  We retrospectively analyzed all patients with an objective psychological and/or neuropsychological diagnosis of lifelong, nonacquired cognitive impairment who had bariatric surgery at our center.
  
  
  RESULTS
  We identified 6 patients with a diagnosis of nonacquired cognitive impairment who underwent a bariatric procedure. The cohort (3 male, 3 female) had a mean age of 33.3 years and a mean body mass index (BMI) of 49.4 kg/m(2). Two of the patients had a diagnosis of trisomy 21, and the other 4 patients had lifelong cognitive impairment from unknown causes. The distribution of surgical approaches was 2 laparoscopic Roux-en-Y gastric bypasses (LRYGBs), 3 laparoscopic sleeve gastrectomies (SGs), and 1 laparoscopic adjustable gastric band (LAGB). There were no complications and no mortality. At a mean follow-up of 33.7 months, the cohort had a mean percent excess weight loss (%EWL) of 31.1% (range -1.8%-72.2%). Two patients achieved a %EWL>50%.
  
  
  CONCLUSIONS
  This case series suggests that bariatric surgery can be performed with minimal morbidity in patients with nonacquired cognitive impairment after intensive multidisciplinary management. However, it appears this population may lose less weight than what is reported for patients without cognitive delay.
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: daiglec2@ccf.org.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Daigle
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Leslie J
authors.initials: LJ
authors.lastname: Heinberg
mesh_terms: D050110:Bariatric Surgery / Q000379:methods*; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome
keywords: Bariatric; Cognitive; Controversial; Gastric bypass; Intellectual disability; Multidisciplinary; Obesity; Sleeve gastrectomy; Trisomy 21