Memory function in early hepatic encephalopathy

Weißenborn, Karin; Heidenreich, Susanne; Giewekemeyer, Kathrin; Rückert, Norbert; Hecker, Hartmut

doi:10.1016/s0168-8278(03)00295-2

Cited by 103 publications

(65 citation statements)

References 15 publications

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“…3 Active drivers should be advised that they have diminished driving abilities and an increased probability of road traffic accidents; active workers ought to have their risk at work evaluated and counselling regarding handling complex/dangerous machinery should be provided; patients with cognitive impairment and decline in work performance perceived by themselves, relatives or by colleagues should be assessed and, if possible, changes in daily/working activities should be carried out. As indexes of quality of life specific for MHE are not available, HR-QoL is usually measured by general indexes such as sickness impact profile, medical outcome study short form-36 (SF- 32 and preventing the progression to overt HE (lactulose 28,30 and probiotics), 8 with minor side effects. Furthermore, optimization of the patient´s nutritional condition conducted periodically by a nutritionist has shown benefit in terms of cognitive performance and HR-QoL.…”

Section: Discussionmentioning

confidence: 99%

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Minimal Hepatic Encephalopathy: The Reality Beyond Our Eyes

et al. 2015

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RESUMOIntrodução: A encefalopatia hepática mínima define-se como um défice neurocognitivo ligeiro, não detectável ao exame clínico, que pode estar presente nos doentes cirróticos. Objectivo: Determinar a prevalência da encefalopatia hepática mínima num hospital prestador de cuidados de saúde secundários no Norte de Portugal. Material e Métodos: Realizou-se um estudo transversal em que foram incluídos os doentes cirróticos seguidos na consulta externa. Critérios de exclusão: encefalopatia hepática clínica, iliteracia, consumo activo de álcool e terapêutica com fármacos psicotrópicos ou lactulose. A presença de encefalopatia hepática mínima foi definida como um valor ≤ -4 na Pontuação Psicométrica da Encefalopatia Hepática, calculado de acordo com as normas portuguesas. Analisaram-se as variáveis: etiologia e gravidade da doença hepática e concentração da amónia sanguínea venosa. Considerou-se o valor de p < 0,05 como significativo. Resultados: Dos 102 doentes avaliados, 41 foram incluídos: 31 homens, idade média de 57 ± 10 anos, escolaridade média de 5 ± 2 anos, 31 Child-Pugh classe A, score MELD médio de 6 ± 3. Foi diagnosticada encefalopatia hepática mínima em 14 (34%) doentes. A presença de encefalopatia hepática mínima não se relacionou com a gravidade da doença hepática. Apesar de mais elevado, o valor médio da concentração da amónia venosa nos doentes com encefalopatia hepática mínima não foi significativamente diferente do valor médio da concentração da amónia venosa nos doentes sem encefalopatia hepática mínima (48,5 ± 13,3 vs. 45,6 ± 15,6 µmol/L, p = 0,555). Discussão: A prevalência da encefalopatia hepática mínima descrita está de acordo com os dados internacionais. Conclusão: A encefalopatia hepática mínima é uma entidade frequente que está presente precocemente na história natural da cirrose, mesmo em doentes compensados. Consequentemente, esta condição escondida deve ser activamente procurada e os doentes devidamente orientados após o diagnóstico. Palavras-chave: Cirrose Hepática; Encefalopatia Hepática; Psicometria; Testes Neuropsicológicos. ABSTRACT Introduction:Minimal hepatic encephalopathy refers to a mild neurocognitive impairment not detectable by clinical examination that can be present in cirrhotic patients. Aim: To determine the prevalence of minimal hepatic encephalopathy in a secondary healthcare center in Northern Portugal. Material and Methods: A cross-sectional study was conducted. Cirrhotic outpatients were included. Exclusion criteria: overt hepatic encephalopathy, illiteracy, active alcohol consumption, psychotropic drug use and therapy with lactulose. The presence of minimal hepatic encephalopathy was defined as a value ≤ -4 on the Psychometric Hepatic Encephalopathy Score, calculated according to the Portuguese norms. Variables analyzed: etiology and severity of liver disease and venous blood ammonia concentration. p values < 0.05 were considered significant. Results: From the 102 patients who were evaluated, 41 were included: 31 males, mean age 57 ± 10 years, mean education 5 ± 2...

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Section: Discussionmentioning

confidence: 99%

“…4 The neurocognitive domains more commonly affected in MHE are the attention, the visuospatial abilities and the fine motor skills. 1,5,6 Also, diminuished memory performance has been described, not due to primary disturbances, 7,8 but mainly as a consequence of the impaired cognitive process (attention and visual perception deficits).…”

Section: Introductionmentioning

confidence: 99%

Minimal Hepatic Encephalopathy: The Reality Beyond Our Eyes

et al. 2015

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“…[23][24][25] They also show reduced memory function, mainly attributed to deficits in attention and visual perception. 26 Although caution must be taken considering the possible deleterious increase in the existing vasodilatation in liver disease by sildenafil, 27 pharmacological manipulation of cGMP in brain by safe procedures may be a useful treatment to restore cognitive and intellectual functions in patients with overt or minimal hepatic encephalopathy.…”

Section: Discussionmentioning

confidence: 99%

Oral administration of sildenafil restores learning ability in rats with hyperammonemia and with portacaval shunts

et al. 2005

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Patients with liver disease with overt or minimal hepatic encephalopathy show impaired intellectual capacity. The underlying molecular mechanism remains unknown. Rats with portacaval anastomosis or with hyperammonemia without liver failure also show impaired learning ability and impaired function of the glutamate-nitric oxide-cyclic guanine monophosphate (glutamate-NO-cGMP) pathway in brain. We hypothesized that pharmacological manipulation of the pathway in order to increase cGMP content could restore learning ability. We show by in vivo brain microdialysis that chronic oral administration of sildenafil, an inhibitor of the phosphodiesterase that degrades cGMP, normalizes the function of the glutamate-NO-cGMP pathway and extracellular cGMP in brain in vivo in rats with portacaval anastomosis or with hyperammonemia. Moreover, sildenafil restored the ability of rats with hyperammonemia or with portacaval shunts to learn a conditional discrimination task.

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“…59 Memory deficits in MHE affects only short-term memory and are due to the attention deficits thereby causing an encoding defect and learning impairment. 59,60 FDG PET studies in MHE patients had shown decreased glucose metabolism in parieto-occipital region involved in visual perception as against preserved metabolism in temporomesial area concerned with memory. 61,62 Experimental data suggests that learning impairment was due to hyperammonemia causing decreased cGMP levels and may respond to pharmacological manipulation.…”

Section: Memory and Learning Difficulties In Minimal Hepatic Encephalmentioning

confidence: 99%

Minimal Hepatic Encephalopathy Impairs Quality of Life

Agrawal

Umapathy

Dhiman

2015

Journal of Clinical and Experimental Hepatology

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Minimal hepatic encephalopathy (MHE) is the mildest form of the spectrum of neurocognitive impairment in cirrhosis. It is a frequent occurrence in patients of cirrhosis and is detectable only by specialized neurocognitive testing. MHE is a clinically significant disorder which impairs daily functioning, driving performance, work capability and learning ability. It also predisposes to the development of overt hepatic encephalopathy, increased falls and increased mortality. This results in impaired quality of life for the patient as well as significant social and economic burden for health providers and care givers. Early detection and treatment of MHE with ammonia lowering therapy can reverse MHE and improve quality of life. ( J CLIN EXP HEPATOL 2015;5:S42-S48) H epatic encephalopathy (HE) is a neurocognitive disorder in which brain function is impaired and is associated with both acute and chronic liver dysfunction. 1 It is a major complication that develops in some form and at some stage in a majority of patients with liver cirrhosis. Minimal HE (MHE) is the mildest form of spectrum of HE which is characterized by subtle cognitive and psychomotor deficits in the absence of recognizable clinical symptoms of HE. 2 It occurs in patients with liver dysfunction and/or portosystemic shunts. In MHE, neurocognitive abnormalities primarily affect attention, speed of information processing, executive control, motor ability and coordination in an individual. 3 In 1970, Zeegen et al 4 first described this condition when they discovered that 38% of patients who had undergone portal decompression surgery scored abnormal in Reitan trail making test (number connection test). Eight years later, the term subclinical HE 5 was introduced to describe these patients. Since then, this condition was described under various names like early HE, latent HE, subclinical HE and finally minimal HE. The latest classification combines MHE and grade 1 HE into covert HE while higher grades are classified as overt HE, thus simplifying the clinical schema so that HE can be uniformly diagnosed. 6 Covert HE means that the mental defect is not detectable by the clinician using conventional testing and is not noticeable to the patient. However, it is significant because these patients usually have neuropsychiatric and neurophysiological abnormalities on advanced testing which are not enough to cause disorientation or asterixis. MHE is regarded as a preclinical stage of HE and ammonia and systemic inflammation plays an important role in its pathogenesis similar to HE. Ammonia lowering therapies were used in the treatment of MHE and found to be effective.MHE is clinically significant as it impairs daily functioning, health related quality of life (HRQOL) and driving skills, predicts the development of overt HE and is associated with poor survival. 7-11 Overt HE develops in >50% of MHE patients within three years. 10 These patients pose a significant burden to their care givers depending on the severity of cognitive dysfunction. 2,12 Considering all ...

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Memory function in early hepatic encephalopathy

Cited by 103 publications

References 15 publications

Minimal Hepatic Encephalopathy: The Reality Beyond Our Eyes

Minimal Hepatic Encephalopathy: The Reality Beyond Our Eyes

Oral administration of sildenafil restores learning ability in rats with hyperammonemia and with portacaval shunts

Minimal Hepatic Encephalopathy Impairs Quality of Life

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