Motor and Cognitive Performance in Patients with Liver Cirrhosis with Minimal Hepatic Encephalopathy

Abstract

<jats:p>Minimal hepatic encephalopathy (MHE) is associated with mild cognitive impairment and frailty. This study aims to identify cognitive and motor differences in cirrhotic patients with and without MHE, and the correlations between motor signs and cognitive performance. Gait, balance, hand strength and motor speed performance were evaluated in 66 cirrhotic patients (38 without and 28 with MHE, according to the Psychometric Hepatic Encephalopathy Score (PHES). Cognitive performance was measured with the Mini-Mental State Examination, Verbal Fluency Test, Aprendizaje Verbal España-Complutense Test (TAVEC), Wechsler Adult Intelligence Scale III, Hamilton Depression and Anxiety Rating Scale and Functioning Assessment Short Test (FAST). MHE patients performed worse than patients without MHE in cognitive and autonomous functioning, learning and long-term memory, and verbal fluency. The same pattern was found in gait, center of pressure movement, variability of hand strength performance and hand motor speed. In MHE patients, high correlations were found between balance and FAST test, gait velocity and verbal skills, hand strength variability and anxiety and depression, and motor speed and FAST and TAVEC. MHE patients showed worse motor and cognitive performance than patients without MHE. MHE patients could have impaired movement control expressed as bradykinesia, and this reduced motor performance could correlate with cognitive performance.</jats:p>

The S1PR2‐CCL2‐BDNF‐TrkB pathway mediates neuroinflammation and motor incoordination in hyperammonaemia

“…Stride length is also reduced in Parkinson's disease [51]. Cirrhotic patients with minimal hepatic encephalopathy also show impaired locomotor gait, with increased stance time [52]. We show here that hyperammonaemic rats show altered locomotion gait with some alterations similar to those observed in Parkinsonism, cerebellar ataxia and cirrhotic patients with minimal hepatic encephalopathy.…”

Identification of minimal hepatic encephalopathy based on dynamic functional connectivity

“…On the neurocognitive impairment severity continuum, minimal hepatic encephalopathy (MHE) is the mildest form and is considered to be the precursor to overt hepatic encephalopathy (OHE) (Hadjihambi, Arias, Sheikh, & Jalan, 2018). MHE is de ned as a condition in which cirrhotic patients have neuropsychiatric and neurophysiological defects despite normal mental status (San Martín-Valenzuela et al, 2020). In recent years, MHE has received considerable attention because of its association with a poor quality of life, decline in daily functioning, increased risk of tra c accidents, and a higher risk of progression to OHE (Labenz et al, 2019;Ridola, Nardelli, Gioia, & Riggio, 2018; A. J.…”

Transdiagnostic neurocognitive deficits in patients with type 2 diabetes mellitus, major depressive disorder, bipolar disorder, and schizophrenia: A 1-year follow-up study

“…Social functioning was evaluated using: (i) the Functional Assessment Short Test (FAST), [17] (ii) the Short Form-36 Health Survey questionnaire (SF-36), [18] and (iii) the WHO Quality of Life-BREF (WHOQOL-BREF). [19] Neurocognitive performance was evaluated using a battery of cognitive tests and subtests previously used by our group [20][21][22][23][24]. Test and subtests scores were divided into seven neurocognitive domains: 1) Learning and verbal memory (L&VM) [(i) Complutense Verbal Learning Test (TAVEC) V3, V8, and V10 variables, [25]] 2) Cognitive Flexibility (CF) [(ii) Stroop Color and Word test (SCWT) Color/Word subtest, [26] and (iii) Wisconsin Card Sorting Test (WCST) Categories Completed and Perseverative Errors scores, [27]] 3) Verbal Fluency (VF) [(iv) Verbal Fluency Tasks (VFT) Semantic and Phonemic forms, [28][29] [(viii) Finger Tapping Test (FTT), [30,33] WAIS-III Digit Symbol Coding subtest, [31] SCWT Color and Word subtests, [26] and TMT Part A, [30]] and three neurocognitive indices, including the Global Cognitive Score (GCS), which was calculated by averaging the seven neurocognitive domain scores; the premorbid Intelligence Quotient (IQ), which was calculated using the WAIS-III vocabulary subtest, considered a classical measure of the level of intelligence prior to the onset of a mental disorder [34]; and the Cognitive Reserve (CR), which was estimated based on the results of the WAIS-III Vocabulary subtest and the number of years of formal education.…”