Background

Patient factors likely impact outcomes from bariatric surgery. One potential factor is cognitive functioning. With more elderly patients and those with developmental delays seeking bariatric surgery, this study examined outcomes for patients with suspected cognitive limitations with regard to surgery completion and post-surgery percent total weight loss (%TWL). All data were abstracted through retrospective medical chart review. Participants were 35 bariatric surgery-seeking patients (Mage = 51.40, MBMI = 47.59); 57.1% female, 85.7% Caucasian, averaging 11.71 years of education. Patients completed pre-bariatric psychological evaluations (June 2012-January 2017) and were subsequently referred for neuropsychological assessment due to low cognitive screening during psychological consultation. Mean IQ (Wechsler Adult Intelligence Scale) was 80.77 (SD = 13.65) corresponding to low average intellectual functioning. Eight individuals were classified as “normal” intellectual functioning, 10 as “low,” 11 as “borderline,” and six as “intellectual disability/extremely low.” Twenty-six patients completed The Wisconsin Card Sorting Task (WCST), a measure of executive functioning. Mean T-score for perseverative errors was 41.50 (SD = 12.31). Eleven (31.4%) patients underwent bariatric surgery (63.7% Roux-en-Y gastric bypass, 36.3% sleeve gastrectomy). Average length to surgery from assessment was 8.2 months. Two patients experienced post-operative complications and one experienced a complication approximately nine months following surgery. Patients exhibited an average of 23.6%TWL six months post-surgery (n = 8), 33.4%TWL one year post-surgery (n = 7), and 31.8%TWL two years post-surgery. For comparison, our general cohort averages 29.35%TWL at one-year post-surgery. Chi-square analyses were conducted to determine if intellectual functioning and WCST performance were related to completion of surgery or weight loss. All analyses were non-significant. Of the 24 people who did not undergo bariatric surgery, three were denied due to cognitive concerns, six experienced unrelated medical issues that postponed bariatric surgery, seven were lost to follow-up, three decided against surgery, two remain in the evaluation process, and three pursued other weight management intervention. Results from this study help begin to understand the process of bariatric surgery evaluation and outcomes for individuals with suspected cognitive limitations. These data suggest that individuals with cognitive limitations should not be precluded from consideration and appear to lose a clinically meaningful amount of weight in the early post-operative period. Clinicians should consider the holistic picture including independent living status, quality of support system, and engagement in pre-bariatric surgery programming to determine bariatric surgery fit. More data is needed on longer-term outcomes and in larger samples of individuals with cognitive limitations.