SAT143 Domains Of Cognitive Dysfunction In Patients With Post-Bariatric Hypoglycemia
Authors: Puleio Alexa Marie , Sheehan Amanda Lyn , Musen Gail J , Patti Mary Elizabeth 
Published: October 2023

Abstract
Disclosure: A.M. Puleio: None. A.L. Sheehan: None. G.J. Musen: None. M. Patti: Consulting Fee; Self; AstraZeneca, Fractyl Laboratories. Other; Self; Eiger Pharmaceuticals - Consulting, MBX Biosceinces - Consulting, Hanmi Pharmaceutical - Consulting, Recordati - Consulting.
Objective: Bariatric surgery is a highly effective treatment for obesity and associated comorbidities. Studies suggest bariatric surgery may result in improved cognitive function and brain volume in parallel with improved cardiometabolic function. However, some post-bariatric individuals develop post-bariatric hypoglycemia (PBH), which can be frequent and severe. Whether repeated episodes of hypoglycemia can impact cognitive function in PBH is unknown. The objective of this pilot study was to determine whether individuals with PBH display reduced cognitive function compared to surgical non-hypoglycemic counterparts. Inclusion/Exclusion Criteria: Adults aged 18-70 years, with a history of Roux-en-Y gastric bypass (RYGB), without a current diagnosis of diabetes, were recruited and enrolled into two groups: individuals with PBH (PBH+), and asymptomatic individuals with history of prior RYGB without hypoglycemia (RYGB non-hypo). Individuals with a history of traumatic brain injury or cerebrovascular accident, active treatment with any medications for diabetes (other than acarbose), active alcohol/substance abuse, known neuroendocrine tumor, or active depression (score &gt;4 for Patient Health Questionnaire-2 (PHQ-2)) were excluded. Methods: Fourteen adults (PBH+, n=7; RYGB non-hypo, n=7) completed assessments of executive function (Delis Kaplan Executive Function System), working memory and attention (Wechsler Memory Scale Third Edition), as well as psychomotor speed (grooved pegboard). Premorbid intelligence was estimated using the National Adult Reading Test. Results: Individuals with PBH+ displayed significantly decreased performance on tests of category fluency (p &lt;0.01), category switching (p &lt;0.01), and category switching accuracy (p &lt;0.01), compared to those in the RYGB non-hypo group. Performance in other verbal fluency measures, including the first (p =0.03) and third interval (p = 0.045), were significantly lower in PBH+ vs. RYGB non-hypo. All other assessments did not differ, including the estimation of premorbid intelligence (p=0.14). Conclusion: PBH+ individuals may be at greater risk for cognitive impairment compared to RYGB non-hypo individuals, as suggested by the impaired semantic processing and cognitive flexibility, as well as greater difficulty initiating and sustaining word retrieval in PBH+. Groups did not differ in cognitive assessments of psychomotor speed, memory, attention, and executive function. Clinicians should be alert for symptoms of cognitive dysfunction in PBH+ patients and consider neurocognitive testing in parallel with assessment of glycemic control, as well as other potential cognitive risk factors. Larger, longitudinal trials are necessary to further elucidate the impact of hypoglycemia on cognition and risk of dementia in patients with PBH.
Presentation: Saturday, June 17, 2023