减重手术与轻度认知障碍、阿尔茨海默病及相关痴呆症发病率降低相关：一项回顾性队列研究。

Bariatric Surgery Is Associated With Reduced Incidence of Mild Cognitive Impairment and Alzheimer Disease and Related Dementias: A Retrospective Cohort Study.

作者信息

Chen You, Feng Yubo, Zhang Xinmeng, Gifford Katherine A, Elmanzalawi Yasser, Samuels Jason, Albaugh Vance L, English Wayne J, Flynn Charles R, Yu Danxia, Zhang Rui, Ikramuddin Sayeed

机构信息

From the Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN.

Department of Computer Science, Vanderbilt University, Nashville, TN.

出版信息

Ann Surg Open. 2025 Jan 10;6(1):e541. doi: 10.1097/AS9.0000000000000541. eCollection 2025 Mar.

DOI:10.1097/AS9.0000000000000541

PMID:40134493

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11932579/

Abstract

OBJECTIVE

To evaluate the association of bariatric surgery with reduced incidence and delayed development of mild cognitive impairment (MCI) and Alzheimer disease and related dementias (ADRD) in patients with obesity.

BACKGROUND

This retrospective longitudinal study utilized Electronic Health Records from Vanderbilt University Medical Center, covering 5303 patients who underwent bariatric surgery and 10,606 propensity score-matched obese patients who did not, from 2000 to 2023. Patients with prior MCI, ADRD, schizophrenia, alcoholism, gastric cancer, gastric ulcers, inflammatory bowel disease, coagulopathy, stroke, Parkinson disease, or brain cancer were excluded from both groups.

METHODS

Differences in time to MCI/ADRD between surgical and control groups were analyzed using linear regression, and adjusted for confounders: demographics, medical history, and socioeconomic status. Survival probability differences for MCI and ADRD between the 2 groups over time were assessed using Kaplan-Meier curves and log-rank tests. Incidence differences of MCI and ADRD between the groups were evaluated using Fine-Gray subdistribution hazard models, accounting for the competing risk of death and confounders.

RESULTS

Bariatric surgery was associated with a significantly reduced incidence of ADRD, evidenced by a subdistribution hazard ratio (SHR) of 0.37 (95% confidence interval [CI]: 0.15-0.89; = 0.03). Similarly, the incidence of MCI was significantly lower in the surgical group, with an SHR of 0.57 (95% CI: 0.39-0.85; = 0.01). Additionally, patients who underwent bariatric surgery experienced a delay of 2.01 years before developing MCI compared with the control group (95% CI: 0.70-3.50; = 0.004).

CONCLUSIONS

These findings suggest that bariatric surgery may serve as an effective strategy to delay the onset of MCI and reduce the risk of both MCI and ADRD in patients with obesity.

摘要

目的

评估减肥手术与肥胖患者轻度认知障碍（MCI）、阿尔茨海默病及相关痴呆症（ADRD）发病率降低和发病延迟之间的关联。

背景

这项回顾性纵向研究利用了范德比尔特大学医学中心的电子健康记录，涵盖了2000年至2023年期间接受减肥手术的5303例患者以及10606例倾向评分匹配的未接受减肥手术的肥胖患者。两组均排除了既往有MCI、ADRD、精神分裂症、酒精中毒、胃癌、胃溃疡、炎症性肠病、凝血病、中风、帕金森病或脑癌的患者。

方法

使用线性回归分析手术组和对照组发生MCI/ADRD的时间差异，并对混杂因素进行调整：人口统计学、病史和社会经济状况。使用Kaplan-Meier曲线和对数秩检验评估两组随时间推移MCI和ADRD的生存概率差异。使用Fine-Gray亚分布风险模型评估两组之间MCI和ADRD的发病率差异，同时考虑死亡的竞争风险和混杂因素。

结果

减肥手术与ADRD发病率显著降低相关，亚分布风险比（SHR）为0.37（95%置信区间[CI]：0.15 - 0.89；P = 0.03）证明了这一点。同样，手术组MCI的发病率显著更低，SHR为0.57（95%CI：0.39 - 0.85；P = 0.01）。此外，与对照组相比，接受减肥手术的患者发生MCI的时间延迟了2.01年（95%CI：0.70 - 3.50；P = 0.004）。