Neuropsychological deficits and morphological MRI brain scan abnormalities in apparently healthy non-encephalopathic patients with cirrhosis

Moore, John W.; Dunk, Arthur A.; Crawford, John R.; Deans, Heather; Besson, J. A. O.; Lacey, Gerald de; Sinclair, T. S.; Mowat, N. A. G.; Brunt, P. W.

doi:10.1016/0168-8278(89)90140-2

Cited by 69 publications

(28 citation statements)

References 15 publications

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“…[3][4][5][6][7][8][9][10][11][12] The prevalence of subclinical hepatic encephalopathy (SHE) is estimated to vary from 30% to 84% according to recent studies using appropriate methods. [12][13][14][15][16] This variation in reported prevalence depends on the kind (psychometric or electrophysiological) and number of tests used, and the population (etiology and severity of the liver disease) tested. 17 SHE is considered to be clinically relevant for two reasons.…”

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confidence: 99%

Subclinical hepatic encephalopathy impairs daily functioning

Groeneweg¹,

Quero²,

Bruijn³

et al. 1998

Hepatology

465

310

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Subclinical hepatic encephalopathy (SHE) is assumed to have a negative effect on patients' daily functioning; therefore, treatment is recommended. However, no studies have been performed that document the clinical relevance of SHE. We performed a study in which the prevalence of SHE was determined in 179 outpatients with cirrhosis using two psychometric tests (Number Connection Test Part A [NCT-A] and the Digit Symbol Test [DGT]) and automated analysis of the electroencephalogram (EEG). SHE was defined by the presence of at least one abnormal psychometric test and/or abnormal slowing of the EEG. The influence of cirrhosis and SHE on patients' daily functioning was assessed using the Sickness Impact Profile (SIP) questionnaire. The distribution of SIP scores of the patients with cirrhosis differed from the reference scores of the general population. Patients with cirrhosis and SHE (n ‫؍‬ 48) reported significantly more impairment in all 12 scales of the SIP, in the psychosocial subscore, the physical subscore, as well as in the total SIP score, compared with cirrhotic patients without SHE (n ‫؍‬ 131). Multivariate analysis taking into account severity of liver disease (Child-Pugh score), presence of varices, and alcoholic etiology, showed that SHE independently was related to a diminished total SIP score. The reproducibility of the SIP was high when the test was repeated after a 3-month period. We conclude that SHE implies impaired daily functioning and warrants attempts at treatment. (HEPATOLOGY 1998;28:45-49.)Clinical manifestations of hepatic encephalopathy include a decreased intellectual function, personality disorders, an altered level of consciousness, and neuromuscular dysfunction. 1 In addition to clinical manifest hepatic encephalopathy, 2 a subclinical stage has been described, which cannot be detected through global clinical examination, but requires specific neuropsychological and neurophysiological examination. [3][4][5][6][7][8][9][10][11][12] The prevalence of subclinical hepatic encephalopathy (SHE) is estimated to vary from 30% to 84% according to recent studies using appropriate methods. [12][13][14][15][16] This variation in reported prevalence depends on the kind (psychometric or electrophysiological) and number of tests used, and the population (etiology and severity of the liver disease) tested. 17

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mentioning

confidence: 99%

Subclinical hepatic encephalopathy impairs daily functioning

Groeneweg¹,

Quero²,

Bruijn³

et al. 1998

Hepatology

465

310

View full text Add to dashboard Cite

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“…[9]. A consensus statement recently proposed a minimal cognitive test battery for the assessment of HE [8] , However, a disadvantage to this test battery is the inclusion of the number connection test [10] which has been shown in several studies to be insensitive to mild HE [11,12]. Nevertheless, there is consistent evidence of psychomotor slowing and memory impairment in subclinical HE.…”

Section: Introductionmentioning

confidence: 99%

“…Oritz and colleagues have recently reported data suggesting that the learning and memory impairment is secondary to an attentional deficit caused by HE [13]. Subclinical HE may be present in the majority of the "healthy" ambulant, non-clinically encephalopathic cirrhotic population, for example, Gitlen et al [7] and Moore et al [11] both reported that over 70% of cirrhotic patients demonstrated impairment in two or more of the cognitive tests employed, compared with 10% or less of those in their control groups.…”

Section: Introductionmentioning

confidence: 99%

Neuropsychological Aspects of Liver Disease and its Treatment

O’Carroll

2007

Neurochem Res

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Liver disease can lead to serious impairment in cognitive functioning, through the development of a condition known as hepatic encephalopathy (HE). While gross impairment is clinically obvious, milder variants of the condition may escape detection at bedside examination and yet may have a significant impact on day-to-day activities. In this brief review article, the neuropsychology of liver disease is examined, focusing on nature, aetiology and significance. The possible contributory role of endogenous benzodiazepines in HE is described, as is the evidence regarding the effect of benzodiazepine antagonism on cognitive functioning in HE. The functional localisation of HE is briefly reviewed, as is the use of neuropsychological measures to evaluate treatment efficacy, e.g. following shunt procedures or liver transplantation. Finally, living donor liver transplantation is described, and the case is made for rigorous longitudinal neuropsychological evaluation of potential donors and recipients.

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“…Memory dysfunction was reported by some authors [7][8][9] ; however, it was not always reported by others. 10 The sensitivity of the number connection test (NCT) itself, the most used psychometric test in cirrhotic patients, is emphasized by some authors, 11,12 but questioned by others 13,14 ; moreover, its neuropsychological interpretation is heterogeneous: it was considered a test of visuo-motor capacity 10 or of attention. 15,16 A clear consensus does exist, however, on the particular alteration of nonverbal intelligence in cirrhotic patients.…”

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confidence: 99%

Visual attention in cirrhotic patients: A study on covert visual attention orienting

et al. 1998

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Attentional dysfunction, which influences overall cognitive productivity, is not well characterized in cirrhotic patients. The aim of this study was to clarify the features of covert visual attention orienting in cirrhotics without overt hepatic encephalopathy. One hundred consecutive cirrhotic patients and 40 controls were enrolled. Visual covert attention orienting was assessed by the Posner test, which evaluates the effect of a cue on visual reaction times. Patients were characterized by the number connection test (NCT) and electroencephalographic (EEG) spectral analysis. The severity of liver disease was graded using standard laboratory parameters and the Child-Pugh's classification. Fifty-five psychometric and EEG evaluations were performed in the follow-up of 17 patients to assess the relationship between the variations of psychometric and neurophysiological findings. NCT and quantified-EEG parameters (altered in 19% and 40% of cirrhotic patients, respectively) were linked to each other and to the severity of liver disease. The Posner test showed a delay of visual reaction times in class B-C cirrhotic patients. Reaction times were correlated with ammonia and EEG parameters. The effect of the cue was higher in cirrhotic patients than in controls, particularly in the invalid position. This study suggests that cirrhotic patients have a reduced activity rate and reduced capacity to disengage attention previously focused on a cue. Such alterations are linked to NCT and EEG findings. (HEPATOLOGY 1998;27:1517-1523.)Cirrhotic patients have a high prevalence, ranging from 30% to 70%, of subtle cognitive or neurophysiological alterations notwithstanding an almost-normal neurological exam. [1][2][3][4][5][6]

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Neuropsychological deficits and morphological MRI brain scan abnormalities in apparently healthy non-encephalopathic patients with cirrhosis

Cited by 69 publications

References 15 publications

Subclinical hepatic encephalopathy impairs daily functioning

Subclinical hepatic encephalopathy impairs daily functioning

Neuropsychological Aspects of Liver Disease and its Treatment

Visual attention in cirrhotic patients: A study on covert visual attention orienting

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