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Published in: Obesity Surgery 9/2018

01-09-2018 | Original Contributions

Performance on the Montreal Cognitive Assessment (MoCA) in Older Adults Presenting for Bariatric Surgery

Authors: Samantha H. Mohun, Mary B. Spitznagel, John Gunstad, Amber Rochette, Leslie J. Heinberg

Published in: Obesity Surgery | Issue 9/2018

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Abstract

Background

Bariatric surgery candidates exhibit cognitive impairment on neuropsychological testing and these deficits are associated with reduced post-operative weight loss. However, less is known about the prevalence of cognitive function in older adults that pursue surgery, despite being at higher risk for cognitive dysfunction.

Objective

To examine the prevalence and profile of cognitive impairment using the Montreal Cognitive Assessment (MoCA) in elderly bariatric patients. We hypothesized that increased body mass index (BMI) and higher number of medications would be linked to lower MoCA score, and that men would evidence poorer MoCA scores than women given past work showing that men presenting for bariatric surgery have more medical comorbidities.

Methods

Data was retrospectively extracted from electronic medical records. Patients 65 and older who completed pre-surgical MoCA assessment and bariatric surgery were included in the study (n = 55).

Results

Twenty-two percent of patients scored below cutoff for impairment on the MoCA. MoCA total score was negatively correlated with BMI and number of medications pre-surgery. There was a significant effect for gender, with men outperforming women.

Conclusions

The current findings suggest that cognitive impairment is common in older adults presenting for bariatric surgery. Future studies are needed to determine the most appropriate methods for detecting cognitive dysfunction in this high-risk population.
Literature
1.
go back to reference Rochette AD, Spitznagel MB, Strain G, et al. Mild cognitive impairment is prevalent in persons with severe obesity. Obesity (Silver Spring). 2016;24:1427–9.CrossRef Rochette AD, Spitznagel MB, Strain G, et al. Mild cognitive impairment is prevalent in persons with severe obesity. Obesity (Silver Spring). 2016;24:1427–9.CrossRef
2.
go back to reference Spitznagel MB, Galioto R, Limbach K, et al. Cognitive function is linked to adherence to bariatric postoperative guidelines. Surg Obes Relat Disord. 2013c;9:580–5.CrossRef Spitznagel MB, Galioto R, Limbach K, et al. Cognitive function is linked to adherence to bariatric postoperative guidelines. Surg Obes Relat Disord. 2013c;9:580–5.CrossRef
3.
go back to reference Spitznagel MB, Garcia S, Miller LA, et al. Cognitive function predicts weight loss after bariatric surgery. Surg Obes Relat Disord. 2013a;9:453–9.CrossRef Spitznagel MB, Garcia S, Miller LA, et al. Cognitive function predicts weight loss after bariatric surgery. Surg Obes Relat Disord. 2013a;9:453–9.CrossRef
4.
go back to reference Spitznagel MB, Alosco M, Strain G, et al. Cognitive function predicts 24-month weight loss success following bariatric surgery. Surg Obes Relat Disord. 2013b;9:765–70.CrossRef Spitznagel MB, Alosco M, Strain G, et al. Cognitive function predicts 24-month weight loss success following bariatric surgery. Surg Obes Relat Disord. 2013b;9:765–70.CrossRef
5.
go back to reference Spitznagel MB, Alosco M, Galioto R, et al. The role of cognitive function in postoperative weight loss outcomes: 36 moth follow-up. Obes Surg. 24:1078–84. Spitznagel MB, Alosco M, Galioto R, et al. The role of cognitive function in postoperative weight loss outcomes: 36 moth follow-up. Obes Surg. 24:1078–84.
6.
go back to reference Flegal KM, Carroll MD, Kit BK, et al. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. J Am Med Assoc. 2012;307(5):491–7.CrossRef Flegal KM, Carroll MD, Kit BK, et al. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. J Am Med Assoc. 2012;307(5):491–7.CrossRef
7.
go back to reference Alosco ML, Spitznagel MB, Gunstad J. Obesity as a risk factor for poor neurocognitive outcomes in older adults with heart failure. Heart Fail Rev. 2014;19:403–11.CrossRef Alosco ML, Spitznagel MB, Gunstad J. Obesity as a risk factor for poor neurocognitive outcomes in older adults with heart failure. Heart Fail Rev. 2014;19:403–11.CrossRef
8.
go back to reference Alosco ML, Cohen R, Spitznagel MB, et al. Older age does not limit post-bariatric surgery cognitive benefits: a preliminary investigation. Surg Obes Relat Dis. 2014;10(6):1196–201.CrossRef Alosco ML, Cohen R, Spitznagel MB, et al. Older age does not limit post-bariatric surgery cognitive benefits: a preliminary investigation. Surg Obes Relat Dis. 2014;10(6):1196–201.CrossRef
9.
go back to reference Stanek KM, Strain G, Devlin M, et al. Body mass index and neurocognitive functioning across the adult lifespan. Neuropsychology. 2013;27:141–51.CrossRef Stanek KM, Strain G, Devlin M, et al. Body mass index and neurocognitive functioning across the adult lifespan. Neuropsychology. 2013;27:141–51.CrossRef
10.
go back to reference Chodosh, J., Petitti, D. B., Elliot, M., Hays, R. D., Crooks, V. C., Reuben, D. B.,. .. Wenger, N. (2004). Physician recognition of cognitive impairment: evaluating the need for improvement. J Am Geriatr Soc, 52, 1051–1059.CrossRef Chodosh, J., Petitti, D. B., Elliot, M., Hays, R. D., Crooks, V. C., Reuben, D. B.,. .. Wenger, N. (2004). Physician recognition of cognitive impairment: evaluating the need for improvement. J Am Geriatr Soc, 52, 1051–1059.CrossRef
11.
go back to reference Valcour VG, Masaki KH, Curb JD, et al. The detection of dementia in the primary care setting. Arch Intern Med. 2000;160:2964–8.CrossRef Valcour VG, Masaki KH, Curb JD, et al. The detection of dementia in the primary care setting. Arch Intern Med. 2000;160:2964–8.CrossRef
12.
go back to reference Petersen RC, Morris JC. Mild cognitive impairment as a clinical entity and treatment target. Arch Neurol. 2005;62:1160–3.CrossRef Petersen RC, Morris JC. Mild cognitive impairment as a clinical entity and treatment target. Arch Neurol. 2005;62:1160–3.CrossRef
13.
go back to reference Galioto R, Garcia S, Sptiznagel MB, et al. The Mini-Mental State Exam (MMSE) is not sensitive to cognitive impairment in bariatric surgery candidates. Surg Obes Relat Dis. 2014;10:553–9.CrossRef Galioto R, Garcia S, Sptiznagel MB, et al. The Mini-Mental State Exam (MMSE) is not sensitive to cognitive impairment in bariatric surgery candidates. Surg Obes Relat Dis. 2014;10:553–9.CrossRef
14.
go back to reference Spitznagel MB, Hawkins M, Alosco M, et al. Neurocognitive effects of obesity and bariatric surgery. Gunstad, J., Eur Eat Disord Rev. 23:488–95. Spitznagel MB, Hawkins M, Alosco M, et al. Neurocognitive effects of obesity and bariatric surgery. Gunstad, J., Eur Eat Disord Rev. 23:488–95.
15.
go back to reference Julayanont, P., & Nasreddine, Z. (2017). Montreal Cognitive Assessment (MoCA): concept and clinical review in A. J. Larner (Ed), Cognitive Screening Instruments. Cham, Switzerland: Springer International Publishing. Julayanont, P., & Nasreddine, Z. (2017). Montreal Cognitive Assessment (MoCA): concept and clinical review in A. J. Larner (Ed), Cognitive Screening Instruments. Cham, Switzerland: Springer International Publishing.
16.
go back to reference Luis CA, Keegan AP, Mullan M. Cross validation of the Montreal Cognitive Assessment in community dwelling older adults residing in the Southeastern US. Int J Geriatr Psychiatry. 2009;24:197–201.CrossRef Luis CA, Keegan AP, Mullan M. Cross validation of the Montreal Cognitive Assessment in community dwelling older adults residing in the Southeastern US. Int J Geriatr Psychiatry. 2009;24:197–201.CrossRef
17.
go back to reference Agmon M, Armon G. A cross-sectional study of the association between mobility test performance and personality among older adults. BioMed Central Geriatr. 2016;16:105.CrossRef Agmon M, Armon G. A cross-sectional study of the association between mobility test performance and personality among older adults. BioMed Central Geriatr. 2016;16:105.CrossRef
18.
go back to reference Farinholt GN, Carr AD, Chang EJ, et al. A call to arms: obese men with more severe comorbid disease and underutilization of bariatric operations. Surg Endosc. 2013;27(12):4556–63.CrossRef Farinholt GN, Carr AD, Chang EJ, et al. A call to arms: obese men with more severe comorbid disease and underutilization of bariatric operations. Surg Endosc. 2013;27(12):4556–63.CrossRef
19.
go back to reference Nasreddine ZS, Phillips NA, Bedirian V, et al. The Montreal Cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53:695–9.CrossRef Nasreddine ZS, Phillips NA, Bedirian V, et al. The Montreal Cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53:695–9.CrossRef
20.
go back to reference Manderino L, Spitznagel MB, Strain G, et al. Cognitive dysfunction predicts poorer emotion recognition in bariatric surgery candidates. Obes Sci Pract. 2015;1:97–103.CrossRef Manderino L, Spitznagel MB, Strain G, et al. Cognitive dysfunction predicts poorer emotion recognition in bariatric surgery candidates. Obes Sci Pract. 2015;1:97–103.CrossRef
21.
go back to reference Gunstad J, Strain G, Devlin MJ, et al. Improved memory function 12 weeks after bariatric surgery. Surg Obes Relat Dis. 2011;7:465–72.CrossRef Gunstad J, Strain G, Devlin MJ, et al. Improved memory function 12 weeks after bariatric surgery. Surg Obes Relat Dis. 2011;7:465–72.CrossRef
22.
go back to reference Libeton M, Dixon JB, Laurie C, et al. Patient motivation for bariatric surgery: characteristics and impact on outcomes. Obes Surg. 2004;14:392–8.CrossRef Libeton M, Dixon JB, Laurie C, et al. Patient motivation for bariatric surgery: characteristics and impact on outcomes. Obes Surg. 2004;14:392–8.CrossRef
23.
go back to reference Mahony D. Psychological gender differences in bariatric surgery candidates. Obesity Surgery. 2007;18(5):607–10.CrossRef Mahony D. Psychological gender differences in bariatric surgery candidates. Obesity Surgery. 2007;18(5):607–10.CrossRef
24.
go back to reference Cheke LG, Simons JS, Clayton NS. Higher BMI is associated with episodic memory deficits in young adults. Q J Exp Psychol. 2015; Cheke LG, Simons JS, Clayton NS. Higher BMI is associated with episodic memory deficits in young adults. Q J Exp Psychol. 2015;
25.
go back to reference Kivipelto M, Ngandu T, Fratiglioni L, et al. Obesity and vascular risk factors at midlife and the risk of dementia and Alzheimer disease. Arch Neurol. 2005;62:1556–60.CrossRef Kivipelto M, Ngandu T, Fratiglioni L, et al. Obesity and vascular risk factors at midlife and the risk of dementia and Alzheimer disease. Arch Neurol. 2005;62:1556–60.CrossRef
Metadata
Title
Performance on the Montreal Cognitive Assessment (MoCA) in Older Adults Presenting for Bariatric Surgery
Authors
Samantha H. Mohun
Mary B. Spitznagel
John Gunstad
Amber Rochette
Leslie J. Heinberg
Publication date
01-09-2018
Publisher
Springer US
Published in
Obesity Surgery / Issue 9/2018
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-018-3206-z

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