# Association of Skeletal Muscle Strength with Cognitive Performance After Metabolic Bariatric Surgery

## TL;DR

This study finds that handgrip strength before surgery predicts cognitive improvements after metabolic bariatric surgery.

## Contribution

Baseline handgrip strength is identified as a novel predictor of post-surgery cognitive outcomes.

## Key findings

- Cognitive performance improved significantly in attention, memory, and executive functions after surgery.
- Baseline handgrip strength, but not muscle mass, predicted cognitive outcomes post-surgery.
- Fat mass and BMI decreased significantly, while lean mass and handgrip strength increased when adjusted for body size.

## Abstract

Background/Objectives: Obesity is associated with cognitive decline, and metabolic bariatric surgery (MBS) can improve both physical and cognitive outcomes. However, cognitive improvements post-surgery are variable. This study explores the role of skeletal muscle health, specifically muscle strength and mass, in cognitive performance after MBS, aiming to identify factors that influence cognitive recovery. Methods: In this prospective study, 55 patients scheduled for MBS were assessed 1 month before and 12 months after surgery. Body composition, including appendicular lean mass (ALM) and fat mass, was measured using dual-energy X-ray absorptiometry (DXA). Handgrip strength (HGS) was assessed via dynamometry, and neurocognitive performance was evaluated using a standardized test battery. Results: Significant improvements in cognitive performance were observed at 12 months post-surgery in attention, memory, language, executive functions and overall cognitive performance. Regarding body composition, significant reductions were observed in fat mass and body mass index (BMI). A decrease in ALM and no changes in HGS were observed; however, when adjusted for body size, both showed an increase. Regression analysis identified baseline HGS, but not muscle mass, as a significant predictor of cognitive performance at 12 months post-surgery. Conclusions: MBS leads to significant improvements in cognitive function. Our results suggest that baseline HGS may play a role in predicting cognitive outcomes post-surgery, highlighting the need for comprehensive assessments of both physical and cognitive health in patients undergoing MBS. Further longitudinal studies are needed to explore causal relationships and the potential reversibility of cognitive deficits post-surgery.