Neural mechanism of cognitive control impairment in patients with hepatic cirrhosis: a functional magnetic resonance imaging study

Zhang, Long Jiang; Yang, Gui Fen; Yin, Jianzhong; Liu, Yawu; Qi, Ji

doi:10.1080/02841850701308378

Cited by 54 publications

(57 citation statements)

References 29 publications

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“…This study demonstrated an early impaired and compensatory neural mechanism during visual judgment already in the earliest stages of HE. Zhang et al 14 used a Chinese character Stroop task as the target stimulus to investigate the neural mechanism of cognitive control impairment in patients with cirrhosis by using the fMRI method, providing further evidence in support of the fact that patients with cirrhosis have impaired cognitive control function and that the abnormal anterior cingulate cortexprefrontal cortex-parietal ''fusiform" cortex circuit could be the neural mechanism responsible for this impaired cognitive control (Fig 6). However, paradigms should be kept simple to isolate specific brain areas in the task-induced fMRI.…”

Section: 6mentioning

confidence: 99%

“…36 Many behavioral studies have claimed the existence of neuropsychological abnormalities, such as attention and fine-motor alterations, in patients with cirrhosis without overt HE. 13,14 Thus, it is rational and feasible to investigate brain function changes in patients with cirrhosis.…”

Section: 6mentioning

confidence: 99%

“…12 The neuropsychological features of MHE point to a disorder of executive functioning, particularly selective attention and psychomotor speed; but other abnormalities, such as working memory, are also seen. 13,14 A complete psychometric assessment by a neuropsychologist is the best way to know the extent of the patient's cognitive impairment. A standardized test battery, including the NCT-A and NCT-B, line-tracing, serial-dotting, and digit-symbol tests (portosystemic encephalopathy syndrome test), has a high specificity for HE compared with other metabolic encephalopathies.…”

Section: Clinical Features Of Hementioning

confidence: 99%

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Multimodality MR Imaging Findings of Low-Grade Brain Edema in Hepatic Encephalopathy

Zhang

Zhong

2012

AJNR Am J Neuroradiol

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SUMMARY: HE is a neuropsychiatric syndrome that develops in patients with severe liver diseases, with portosystemic shunt surgery in the form of diffuse mild brain edema. It is also associated with functional changes, such as those in attention and the DMN. MR imaging offers a range of capabilities for assessing the low-grade brain edema and its functional changes in brain affected by HE; therefore, it provides the opportunity to uncover the pathophysiologic mechanisms of HE. This article will review our current understanding of the pathophysiology of low-grade brain edema and will outline the role of structural MR imaging, MTR, DWI, DTI, and MR spectroscopy in the detection of low-grade brain edema, and the role of BOLD fMRI in the exploration of the related functional changes. A perspective of the study in this area will also be provided. ABBREVIATIONS:ALFF ϭ amplitude of low-frequency fluctuation; BOLD ϭ blood oxygen levelϪdependent; DMN ϭ default mode network; FA ϭ fractional

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Section: 6mentioning

confidence: 99%

Section: 6mentioning

confidence: 99%

Section: Clinical Features Of Hementioning

confidence: 99%

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Multimodality MR Imaging Findings of Low-Grade Brain Edema in Hepatic Encephalopathy

Zhang

Zhong

2012

AJNR Am J Neuroradiol

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“…Zafiris and colleagues demonstrated that MHE is associated with impaired coupling between visual judgment areas (70). A study conducted by Zhang and colleagues compared brain fMRI data in 14 patients with cirrhosis and 14 healthy volunteers (71). An incongruous word reading task and incongruous color-naming task (testing for attention and interference) highlighted various cerebral areas on fMRI: there was greater activation of the bilateral parietal and prefrontal cortices in the patients with cirrhosis (72).…”

Section: Functional Mrimentioning

confidence: 99%

Brain Imaging and Hepatic Encephalopathy

McPhail

Patel

Taylor‐Robinson

2012

Clinics in Liver Disease

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KEY WORDSHepatic encephalopathy; Brain imaging; Magnetic resonance imaging; Magnetic resonance spectroscopy, Computed tomography, Single photon emission computed tomography; Positron emission tomography. 2 SYNOPSISNovel imaging techniques are allowing hepatologists to investigate the structural and functional neuropathology of hepatic encephalopathy (HE) in greater detail but only limited techniques are applicable to the clinic. Computed tomography and magnetic resonance imaging (MRI) can rule out other diagnoses and in the case of MRI, give certain key diagnostic features in widely available sequences. While increased brain water content is a hallmark of HE, the localisation of low-grade cerebral edema, the extent of regional swelling or atrophy and the different functional characteristics of affected brain regions continue to be debated. More specialised volumetric, diffusion-tensor, magnetization transfer, functional magnetic resonance imaging and magnetic resonance spectroscopy, in conjunction with positron emission tomography continue to enrich the investigative findings in HE. Nevertheless an internationally accepted diagnostic framework that includes an objective imaging test to replace or augment psychometry remains elusive. Quantitative MRI is likely to be the best candidate to become such a test and the utility of MR and nuclear medical techniques to the clinic and results from recent research are described in this article.3

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“…Abnormal suppression occurs in epilepsy, 10 attention deficit hyperactivity disorder, 11 Alzheimer disease, 12 and traumatic brain injury. 13 Studies in patients with cirrhosis have demonstrated functional connectivity between regions including the anterior and posterior cingulate cortices, parietal lobe, and fusiform gyrus, 14 and abnormal deactivation of the posterior cingulate, precuneus, and ventral medial prefrontal cortices. 15 DMN activation and altered neural functioning during MHE treatment are not known.…”

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confidence: 99%

Modulation of neural activation following treatment of hepatic encephalopathy

et al. 2013

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Objective: To measure changes in psychometric state, neural activation, brain volume (BV), and cerebral metabolite concentrations during treatment of minimal hepatic encephalopathy.Methods: As proof of principle, 22 patients with well-compensated, biopsy-proven cirrhosis of differing etiology and previous minimal hepatic encephalopathy were treated with oral L-ornithine L-aspartate for 4 weeks. Baseline and 4-week clinical review, blood chemistry, and psychometric evaluation (Psychometric Hepatic Encephalopathy Score and Cognitive Drug Research Score) were performed. Whole-brain volumetric and functional MRI was conducted using a highly simplistic visuomotor task, together with proton magnetic resonance spectroscopy of the basal ganglia. Treatment-related changes in regional BV and neural activation change (blood oxygenation level dependent) were assessed.Results: Although there was no change in clinical, biochemical state, basal ganglia magnetic resonance spectroscopy, or in regional BV, there were significant improvements in Cognitive Drug Research Score (11.2, p 5 0.003) and Psychometric Hepatic Encephalopathy Score (11.5, p 5 0.003) with treatment. This cognitive amelioration was accompanied by changes in blood oxygenation leveldependent activation in the posterior cingulate and ventral medial prefrontal cortex, 2 regions that form part of the brain's structural and metabolic core. In addition, there was evidence of greater visual cortex activation. Conclusions:These structurally interconnected regions all showed increased function after successful encephalopathy treatment. Because no regional change in BV was observed, this implies that mechanisms unrelated to astrocyte volume regulation were involved in the significant improvement in cognitive performance. LOLA 5 L-ornithine L-aspartate; MD 5 mean difference; MELD 5 model for end-stage liver disease; MHE 5 minimal hepatic encephalopathy; mI 5 myo-inositol; MRS 5 magnetic resonance spectroscopy; NAA 5 N-acetylaspartate; OHE 5 overt hepatic encephalopathy; PHES 5 Psychometric Hepatic Encephalopathy Score; QoEM 5 Quality of Episodic Memory; SIENA 5 Structural Image Evaluation, using Normalisation, of Atrophy; SoM 5 Speed of Memory; TE 5 echo time; TR 5 repetition time.

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Neural mechanism of cognitive control impairment in patients with hepatic cirrhosis: a functional magnetic resonance imaging study

Abstract: This study demonstrates that patients with hepatic cirrhostic have cognitive control deficiency. The abnormal brain network of the ACC-PFC-parietal lobe-TFG is the neural basis of cognitive control impairment in cirrhotic patients.

Cited by 54 publications

References 29 publications

Multimodality MR Imaging Findings of Low-Grade Brain Edema in Hepatic Encephalopathy

Multimodality MR Imaging Findings of Low-Grade Brain Edema in Hepatic Encephalopathy

Brain Imaging and Hepatic Encephalopathy

Modulation of neural activation following treatment of hepatic encephalopathy

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