Differences in cognitive function between patients with viral and alcoholic compensated liver cirrhosis

Abstract

As alcohol induces change in frontal cortex primarily involved in cognition, cognitive function may be different between viral and alcoholic liver cirrhosis (LC). This study aimed to determine the differences of cognitive function between viral and alcoholic compensated LC. From October 2011 to March 2013, 80 patients (viral: 37; alcohol: 43) with compensated LC were prospectively enrolled. Neuropsychological functions including attention, language, visuospatial, verbal memory, visual memory, and frontal/executive function were evaluated between two groups and compared with age-matched normal group (n = 1000). Cumulative incidence rate of overt hepatic encephalopathy (HE) was calculated. In the comparison with normal group, both two groups showed decreased memory function, frontal/executive function, and Korea-Mini Mental Status Examination. In the analysis of two groups, memory function by Verbal Learning Test (recognition: 20.1 ± 3.6 and 17.8 ± 4.8, p = 0.022), visuospatial function by Ray-Complex Figure Copy Test (recognition: 19.0 ± 2.6 and 17.3 ± 4.0, p = 0.043), frontal/executive function by Controlled Oral Ward Association (semantic: 17.1 ± 6.9 and 12.7 ± 6.9, p = 0.004), and the Korea-Mini Mental Status Examination (27.5 ± 1.9 and 26.2 ± 3.1, p = 0.03) showed low scores in alcoholic compensated LC patients. The 1-, 2-, and 3-year cumulative incidence rates of overt HE were 23%, 26%, and 26% and 33%, 43%, and 49% in the viral and alcoholic compensated LC group, respectively (p = 0.033). Impaired memory and frontal lobe executive functions and early development of overt HE were more common in patients with alcoholic LC. For patients with alcoholic LC, more integrated tests for early detection of minimal HE and intensive treatment should be considered to prevent overt HE.

Disrupted Brain Intrinsic Networks and Executive Dysfunction in Cirrhotic Patients without Overt Hepatic Encephalopathy

“…First, the etiology of cirrhosis was heterogeneous in the patients. Given that the distinct etiologies could lead to the differences in behavioral and cerebral structural changes in patients ( 45 , 46 ), future studies should examine altered FC in intrinsic brain networks and its relationship with executive function changes in patients with specific cirrhosis etiologies. Second, physiological noise should be considered in resting-state FC analysis.…”

Nutritional Status and Diet Style Affect Cognitive Function in Alcoholic Liver Disease

“…In our previous report, impaired memory and frontal lobe executive functions and early development of overt encephalopathy were more common in patients with ALD [16]. However, limited data about the relation between malnutrition and cognitive dysfunction in ALD are available.…”

“…Alcohol intoxication reduces brain activity in the cortical and subcortical regions, including the temporal lobe, which contains the hippocampus [37]. In cirrhosis and advanced ALD, atrophic changes in the brain are dominant [16], but functional changes take precedence over structural changes in alcohol use disorder. In our data, pathological examination revealed hepatitis not cirrhosis and did not reveal differences in synapsin1, synaptophysin, SNAP25, PSD95, synaptotagmin, and…”

Functional Network-Based Statistics Reveal Abnormal Resting-State Functional Connectivity in Minimal Hepatic Encephalopathy

“…Second, our design did not enable us to control for the potential confounding effects of heterogeneous etiologies of cirrhosis (e.g., the residual effect of past alcohol abuse). Previous studies have demonstrated that distinct etiologies could induce different degrees of brain structural and functional changes in cirrhotic patients (47, 48). Third, we could not evaluate whether network-wise FCs are related to deficits in specific cognitive domains (e.g., memory, attention, and executive domains), since only a general cognition assessment (i.e., the PHES examination) was performed.…”