Cognitive Dysfunction in Liver Disease and Its Implications for Transplant Candidates

Ruck, Jessica M.; King, Elizabeth A.; Chu, Nadia M.; Segev, Dorry L.; McAdams‐DeMarco, Mara

doi:10.1007/s40472-023-00390-9

Cited by 2 publications

(4 citation statements)

References 44 publications

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“…Median (Q1-Q3) time between pre-LT MoCA and LT was 7 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13) months and between LT and post-LT MoCA was 7 (5)(6)(7)(8)(9)(10)(11)…”

Section: Resultsmentioning

confidence: 99%

“…Liver transplant (LT) recipients have a high burden of factors known to lead to cognitive impairment in other populations (e.g., dislipidemia, diabetes mellitus, chronic alcohol use), 1–3 yet few studies have explored cognitive function in this population. Available data are largely from small, non‐United States (US) cohorts with limited generalizability to US LT recipients 4–7 .…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of cognitive impairment in liver transplant recipients

Berry,

Ruck,

Barry

et al. 2023

Clinical Transplantation

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Liver transplant (LT) recipients have a high burden of cognitive impairment risk factors identified in other populations, yet little work has explored cognition in the United States LT population. We characterized prevalence of cognitive impairment (CI) in LT recipients pre‐LT and ≥3 months post‐LT. Adult LT recipients with cirrhosis but without active pre‐LT hepatic encephalopathy (HE) were screened for CI using the Montreal Cognitive Assessment (MoCA) for CI (MoCA <24) both pre‐LT and ≥3 months post‐LT. The association between cognitive performance and recipient characteristics was assessed using logistic regression. Of 107 LT recipients, 36% had pre‐LT CI and 27% had post‐LT CI [median (Q1–Q3) MoCA 26 (23–28)]. Each 1‐point increase in pre‐LT MoCA was associated with 26% lower odds of post‐LT cognitive impairment (aOR .74, 95% CI .63–.87, p < .001), after adjusting for recipient age, history of HE, and time since LT. In this study of cirrhosis recipients without active pre‐LT HE, cognitive impairment was prevalent before LT and remained prevalent ≥3 months after LT (27%), long after effects of portal hypertension on cognition would be expected to have resolved. Our data expose an urgent need for more comprehensive neurologic examination of LT recipients to better identify, characterize, and address predictors of post‐LT cognitive impairment.

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“…Median (Q1-Q3) time between pre-LT MoCA and LT was 7 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13) months and between LT and post-LT MoCA was 7 (5)(6)(7)(8)(9)(10)(11)…”

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prevalence of cognitive impairment in liver transplant recipients

Berry,

Ruck,

Barry

et al. 2023

Clinical Transplantation

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“…However, there is evidence that some LT recipients have persistent CI post-transplant, 3 likely due to an etiology other than liver disease. 4 For this reason, reliably identifying potential LT candidates with more than mild impairment is important to pre-transplant counseling, decision-making, and optimization. 5 However, objective assessment of the presence and severity of CI pre-LT is not universally performed.…”

Section: Introductionmentioning

confidence: 99%

“…Unfortunately, among potential LT candidates, pre‐transplant CI may be underappreciated, as many providers expect and counsel that CI is likely to resolve once the candidate has received their transplant. However, there is evidence that some LT recipients have persistent CI post‐transplant, 3 likely due to an etiology other than liver disease 4 . For this reason, reliably identifying potential LT candidates with more than mild impairment is important to pre‐transplant counseling, decision‐making, and optimization 5 .…”

Section: Introductionmentioning

confidence: 99%

A pragmatic tool to screen for pre‐transplant cognitive impairment among potential candidates for liver transplant

Teles,

Ruck,

Jefferis

et al. 2024

Clinical Transplantation

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IntroductionCognitive impairment (CI) among liver transplant (LT) candidates is associated with increased risk of waitlist mortality and inferior outcomes. While formal neurocognitive evaluation is the gold standard for CI diagnosis, the Montreal Cognitive Assessment (MoCA) is often used for first‐line cognitive screening. However, MoCA requires specialized training and may be too lengthy for a busy evaluation appointment. An alternate approach may be the Quick Dementia Rating System (QDRS), which is patient‐ and informant‐based and can be administered quickly. We compared potential LT candidates identified by MoCA and QDRS as potentially benefiting from further formal cognitive evaluation.MethodsWe identified 46 potential LT candidates enrolled at a single center of a prospective, observational cohort study who were administered MoCA and QDRS during transplant evaluation (12/2021–12/2022). Scores were dichotomized as (1) normal versus abnormal and (2) normal/mild impairment versus more‐than‐mild impairment. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of QDRS compared to MoCA.ResultsBy MoCA, this population had a prevalence of 48% normal cognition, 48% mild, 4% moderate, and 0% severe impairment. This was categorized as 96% normal/mild and 4% more‐than‐mild impairment. When comparing to MoCA cognitive screening, QDRS had a sensitivity of 61%, specificity of 56%, NPV of 56%, and PPV of 61%. When identifying more‐than‐mild impairment, QDRS had a sensitivity of 100%, specificity of 73%, NPV of 100%, and PPV of 10%.ConclusionThe high sensitivity and NPV of QDRS in identifying more‐than‐mild impairment suggests it could identify potential LT candidates who would benefit from further formal cognitive evaluation. The ability to administer QDRS quickly and remotely makes it a pragmatic option for pre‐transplant screening.

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Cognitive Dysfunction in Liver Disease and Its Implications for Transplant Candidates

Cited by 2 publications

References 44 publications

Prevalence of cognitive impairment in liver transplant recipients

Prevalence of cognitive impairment in liver transplant recipients

A pragmatic tool to screen for pre‐transplant cognitive impairment among potential candidates for liver transplant

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