Abstract
BACKGROUND AND AIM: Subclinical hepatic encephalopathy (HE) in cirrhotic patients is usually characterized by memory impairment and psychomotor slowing. Our aim was to investigate memory status in cirrhotic patients with and without clinically overt HE. MATERIAL AND METHODS: Thirty-two cirrhotic patients (10 female and 22 male) aged 49 +/- 17 years and 20 healthy subjects (six female and 14 male) aged 46 +/- 12 years were included in the study. Memory status was defined by Wechsler Memory Scale, verbal memory process and complex memory process tests. RESULTS: Grade-1 HE was detected in 7 (22%) patients with cirrhosis. We detected 36 to 92% decrement in various memory tests in cirrhotic patients without HE as compared to healthy subjects. The scores for all psychometric testing results were significantly lower in cirrhotic patients without HE as compared to healthy subjects. We detected 42.9 to 100% decrement in various memory tests in cirrhotic patients with HE than cirrhotic patients without HE. However, there was no statistical significant difference between cirrhotic patients with and without HE. There was no statistical significant difference in cirrhotic patients with Child-Pugh A, B, and C. CONCLUSION: In conclusion, memory status was influenced in which patients with cirrhosis yet has a normal mental and neurological status to routine clinical examination (subclinical HE). Occasionally, decreased memory performance may adversely affect the satisfaction and lifestyle of these patients. Therefore, subclinical HE is an important social problem.
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- Amodio P., Marchetti P., Del Piccolo F., Campo G., Rizzo C., Iemmolo R. M., Gerunda G., Caregaro L., Merkel C., Gatta A. Visual attention in cirrhotic patients: a study on covert visual attention orienting. Hepatology. 1998 Jun;27(6):1517–1523. doi: 10.1002/hep.510270608. [DOI] [PubMed] [Google Scholar]
- Amodio P., Quero J. C., Del Piccolo F., Gatta A., Schalm S. W. Diagnostic tools for the detection of subclinical hepatic encephalopathy: comparison of standard and computerized psychometric tests with spectral-EEG. Metab Brain Dis. 1996 Dec;11(4):315–327. doi: 10.1007/BF02029493. [DOI] [PubMed] [Google Scholar]
- Benton A. L. Abbreviated versions of the Visual Retention Test. J Psychol. 1972 Mar;80(2D):189–192. doi: 10.1080/00223980.1972.9924794. [DOI] [PubMed] [Google Scholar]
- Butterworth R. F. Pathogenesis and treatment of portal-systemic encephalopathy: an update. Dig Dis Sci. 1992 Mar;37(3):321–327. doi: 10.1007/BF01307722. [DOI] [PubMed] [Google Scholar]
- Conn H. O. Trailmaking and number-connection tests in the assessment of mental state in portal systemic encephalopathy. Am J Dig Dis. 1977 Jun;22(6):541–550. doi: 10.1007/BF01072510. [DOI] [PubMed] [Google Scholar]
- Das A., Dhiman R. K., Saraswat V. A., Verma M., Naik S. R. Prevalence and natural history of subclinical hepatic encephalopathy in cirrhosis. J Gastroenterol Hepatol. 2001 May;16(5):531–535. doi: 10.1046/j.1440-1746.2001.02487.x. [DOI] [PubMed] [Google Scholar]
- Gilberstadt S. J., Gilberstadt H., Zieve L., Buegel B., Collier R. O., Jr, McClain C. J. Psychomotor performance defects in cirrhotic patients without overt encephalopathy. Arch Intern Med. 1980 Apr;140(4):519–521. [PubMed] [Google Scholar]
- Gitlin N., Lewis D. C., Hinkley L. The diagnosis and prevalence of subclinical hepatic encephalopathy in apparently healthy, ambulant, non-shunted patients with cirrhosis. J Hepatol. 1986;3(1):75–82. doi: 10.1016/s0168-8278(86)80149-0. [DOI] [PubMed] [Google Scholar]
- Gitlin N. Subclinical portal-systemic encephalopathy. Am J Gastroenterol. 1988 Jan;83(1):8–11. [PubMed] [Google Scholar]
- Goh J., Coughlan B., Quinn J., O'Keane J. C., Crowe J. Fatigue does not correlate with the degree of hepatitis or the presence of autoimmune disorders in chronic hepatitis C infection. Eur J Gastroenterol Hepatol. 1999 Aug;11(8):833–838. doi: 10.1097/00042737-199908000-00004. [DOI] [PubMed] [Google Scholar]
- Groeneweg M., Quero J. C., De Bruijn I., Hartmann I. J., Essink-bot M. L., Hop W. C., Schalm S. W. Subclinical hepatic encephalopathy impairs daily functioning. Hepatology. 1998 Jul;28(1):45–49. doi: 10.1002/hep.510280108. [DOI] [PubMed] [Google Scholar]
- McClain C. J., Potter T. J., Kromhout J. P., Zieve L. The effect of lactulose on psychomotor performance tests in alcoholic cirrhotics without overt hepatic encephalopathy. J Clin Gastroenterol. 1984 Aug;6(4):325–329. [PubMed] [Google Scholar]
- Moore J. W., Dunk A. A., Crawford J. R., Deans H., Besson J. A., De Lacey G., Sinclair T. S., Mowat N. A., Brunt P. W. Neuropsychological deficits and morphological MRI brain scan abnormalities in apparently healthy non-encephalopathic patients with cirrhosis. A controlled study. J Hepatol. 1989 Nov;9(3):319–325. doi: 10.1016/0168-8278(89)90140-2. [DOI] [PubMed] [Google Scholar]
- O'Carroll R. E., Hayes P. C., Ebmeier K. P., Dougall N., Murray C., Best J. J., Bouchier I. A., Goodwin G. M. Regional cerebral blood flow and cognitive function in patients with chronic liver disease. Lancet. 1991 May 25;337(8752):1250–1253. doi: 10.1016/0140-6736(91)92920-w. [DOI] [PubMed] [Google Scholar]
- PARSONS-SMITH B. G., SUMMERSKILL W. H., DAWSON A. M., SHERLOCK S. The electroencephalograph in liver disease. Lancet. 1957 Nov 2;273(7001):867–871. doi: 10.1016/s0140-6736(57)90005-3. [DOI] [PubMed] [Google Scholar]
- Quero J. C., Hartmann I. J., Meulstee J., Hop W. C., Schalm S. W. The diagnosis of subclinical hepatic encephalopathy in patients with cirrhosis using neuropsychological tests and automated electroencephalogram analysis. Hepatology. 1996 Sep;24(3):556–560. doi: 10.1002/hep.510240316. [DOI] [PubMed] [Google Scholar]
- Rikkers L., Jenko P., Rudman D., Freides D. Subclinical hepatic encephalopathy: detection, prevalence, and relationship to nitrogen metabolism. Gastroenterology. 1978 Sep;75(3):462–469. [PubMed] [Google Scholar]
- Schomerus H., Hamster W., Blunck H., Reinhard U., Mayer K., Dölle W. Latent portasystemic encephalopathy. I. Nature of cerebral functional defects and their effect on fitness to drive. Dig Dis Sci. 1981 Jul;26(7):622–630. doi: 10.1007/BF01367675. [DOI] [PubMed] [Google Scholar]
- Schomerus H., Schreiegg J. Prevalence of latent portasystemic encephalopathy in an unselected population of patients with liver cirrhosis in general practice. Z Gastroenterol. 1993 Apr;31(4):231–234. [PubMed] [Google Scholar]
- Sood G. K., Sarin S. K., Mahaptra J., Broor S. L. Comparative efficacy of psychometric tests in detection of subclinical hepatic encephalopathy in nonalcoholic cirrhotics: search for a rational approach. Am J Gastroenterol. 1989 Feb;84(2):156–159. [PubMed] [Google Scholar]
- Srivastava A., Mehta R., Rothke S. P., Rademaker A. W., Blei A. T. Fitness to drive in patients with cirrhosis and portal-systemic shunting: a pilot study evaluating driving performance. J Hepatol. 1994 Dec;21(6):1023–1028. doi: 10.1016/s0168-8278(05)80612-9. [DOI] [PubMed] [Google Scholar]
- Tarter R. E., Arria A. M., Carra J., Van Thiel D. H. Memory impairments concomitant with nonalcoholic cirrhosis. Int J Neurosci. 1987 Feb;32(3-4):853–859. doi: 10.3109/00207458709043340. [DOI] [PubMed] [Google Scholar]
- Van der Rijt C. C., Schalm S. W., De Groot G. H., De Vlieger M. Objective measurement of hepatic encephalopathy by means of automated EEG analysis. Electroencephalogr Clin Neurophysiol. 1984 May;57(5):423–426. doi: 10.1016/0013-4694(84)90071-3. [DOI] [PubMed] [Google Scholar]
- Watanabe A., Sakai T., Sato S., Imai F., Ohto M., Arakawa Y., Toda G., Kobayashi K., Muto Y., Tsujii T. Clinical efficacy of lactulose in cirrhotic patients with and without subclinical hepatic encephalopathy. Hepatology. 1997 Dec;26(6):1410–1414. doi: 10.1053/jhep.1997.v26.pm0009397979. [DOI] [PubMed] [Google Scholar]
- Yang S. S., Chu N. S., Liaw Y. F. Somatosensory evoked potentials in hepatic encephalopathy. Gastroenterology. 1985 Sep;89(3):625–630. doi: 10.1016/0016-5085(85)90460-3. [DOI] [PubMed] [Google Scholar]
