Cognitive and neurophysiological assessment of patients with minimal hepatic encephalopathy in Brazil

Torres, Daniel Simplício; Abrantes, Jefferson; Brandão‐Mello, Carlos Eduardo

doi:10.1038/s41598-020-65307-3

Cited by 6 publications

(5 citation statements)

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“…A further limitation was the heterogeneous diagnostic tools, with unknown cross-comparability used to measure cognitive function, making the comparison of research findings difficult. This limitation has also been raised in previous reviews, where there is an urgent need for consensus on using standard cognitive assessments [ 44 , 45 ]. In addition, due to the heterogeneity of populations, with regard to co-morbidities and severity of NAFLD and tools to assess cognition amongst studies and the scarcity of literature reporting on the relationship between NAFLD and cognitive function, a meta-analysis could not be conducted.…”

Section: Discussionmentioning

confidence: 99%

Is there an association between non-alcoholic fatty liver disease and cognitive function? A systematic review

et al. 2022

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Background Non-alcoholic fatty liver disease (NAFLD) is represented as the most common liver disease worldwide. NAFLD is associated with metabolic risk factors underpinned by insulin resistance, inflammation and endothelial dysfunction, leading to extrahepatic changes in central nervous diseases such as cognitive impairment, Alzheimer’s disease and dementia. The aim of the review is to explore the association between NAFLD and cognitive function. Methods Using the PRISMA guidelines, a systematic electronic literature search was conducted in four databases: MEDLINE, PsychINFO, Embase and CINAHL from inception until March 2021. Neuropsychological tests utilised within each study were grouped into relevant cognitive domains including ‘general cognition’, ‘reasoning’, ‘mental speed, attention and psychomotor speed’, ‘memory and learning’, ‘language’, ‘visuospatial perception’ and ‘ideas, abstraction, figural creations and mental flexibility’. Results Eleven observational studies that involved 7978 participants with a mean age of 51 years were included. Those with NAFLD had poor cognitive performance in three cognitive domains, including ‘general cognition’, ‘mental speed, attention and psychomotor speed’, and ‘ideas, abstraction, figural creations and mental flexibility’. Conclusion The observed results from the 11 included studies showed that NAFLD was associated with lower cognitive performance across several domains. However, studies conducted to date are limited to observational designs and are heterogeneous with varying diagnostic tools used to assess cognitive function. Trial registration PROSPERO Registration: CRD42020161640.

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Section: Discussionmentioning

confidence: 99%

Is there an association between non-alcoholic fatty liver disease and cognitive function? A systematic review

et al. 2022

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“…Por lo tanto, se concluyó que el efecto de los probióticos puede ser considerada como una nueva alternativa coadyuvante en el manejo de la encefalopatía hepática de cambios mínimos, puesto que ayuda en la modulación del microbiota intestinal disminuyendo los niveles de amoniaco en el organismo, mejorando el estado de conciencia y la calidad de vida de los pacientes que se ve afectada por esta patología. (Torres et al, 2020).…”

Section: Discussionunclassified

“…Se encontraron diferencias significativas entre los que respondieron y los que no respondieron a la lactulosa en Actino bacteria, Bacteroidetes, Firmicutes y Proteobacteria. Q1 (Torres et al, 2020) USA Se evidencio que la composición del microbiota en 5 pacientes con cirrosis hepática y EHM tratados con rifaximina 550 mg dos veces al día sola de forma continua durante un período de 3 meses o combinada con lactulosa 30-60 ml al día durante 3 meses. Además de las evaluaciones clínicas de EH, se analizaron biopsias de duodeno y muestras de heces para detectar su comunidad bacteriana específica aplicando NGS después del aislamiento de ARN antes del tratamiento, después de 3 meses de tratamiento y 3 meses después de finalizar el tratamiento.…”

Section: Ninety-eight Pacientesunclassified

“…Fue descrita por primera vez por Zeegen y Cols en 1970 en ciertos pacientes que tras ser sometidos a un procedimiento quirúrgico de derivación portal mostraron deterioro en la prueba psicométrico numérico, siendo una de las enfermedades con gran impacto a nivel salud, social y económico. Se trata de una de las condiciones más difícil de diagnosticar puesto que el paciente presenta síntomas subclínicos que no se puede detectar con facilidad mediante la exploración física neurológica, solo se puede verificar por pruebas psicométricas y electrofisiológicas que son los métodos estándar para el diagnóstico de esta patología (Faccioli et al, 2022;Torres et al, 2020).…”

Section: Introductionunclassified

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Eficacia del uso de probióticos como profilaxis en pacientes con encefalopatía hepática de cambios mínimos

Toaza Gutama,

Orellana Bernal

2023

ConcienciaDigital

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Introducción. la encefalopatía hepática de cambios mínimos es la presentación más leve que se caracteriza por alteraciones subclínicas inespecíficas que no son evidentes mediante la exploración física, la cual se debe a la incapacidad del hígado de eliminar las toxinas originadas en el intestino siendo el amoniaco la principal toxina , en la actualidad se considera que los probióticos representan un gran avance en esta patología, la misma que va actuar disminuyendo la cantidad de microorganismos patógenos facilitando el exceso de amoniaco a nivel cerebral. Objetivo. describir la eficacia de los probióticos como profilaxis secundaria en pacientes con encefalopatía hepática de cambios mínimos. Metodología. es un estudio de revisión bibliográfica tipo narrativa, una revisión amplia de la literatura, sobre la eficacia del uso de probióticos como profilaxis en pacientes con encefalopatía hepática de cambios minimos en bases de datos científicas, como Pub Med, Scielo, Biblioteca Cochrane, y Science Direct, mediante parte de la estrategia PRISMA. Resultados. se revisaron 51 estudios, que recopilaron las principales recomendaciones sobre la importancia del diagnóstico del streptococo b hemolitico en el embarazo en bases de datos científicas, como Pub Med, Scielo, Biblioteca Cochrane, y Science Direct, mediante parte de la estrategia PRISMA. Conclusión. el empleo de probióticos ha demostrado tener efectos positivos en el manejo y prevencion de la encefalopatia hepatica de cambios minimos, principalmente cuando se emplean en diferentes combinaciones de varias cepas bacterianas y otros farmacos coadyucantes. Ademas se debe destacar que son economicos y de facil acceso, los estudios planteadoos exponen su eficiacia en el tratamiento de diferentes hepatopatías, así como en la prevención de las complicaciones de la cirrosis, debido a su capacidad para modular la flora intestinal, la permeabilidad intestinal y la respuesta inmune. Área de estudio general: medicina. Área de estudio específica: medicina general.

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“…In addition, selective impairments of psychomotor speed, visual perception, and attention have been reported in patients with cirrhosis without clinical signs of hepatic encephalopathy [ 13 , 14 ]. These selective impairments have been termed minimal hepatic encephalopathy (MHE) [ 13 , 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Hepatitis C Virus (HCV) Infection and Neurocognitive Impairment in Subjects with Mild Liver Disease

Amendola-Pires

Fakoury

Salazar

et al. 2023

JCM

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Hepatitis C virus (HCV) infection is a leading cause of liver cirrhosis, hepatocellular carcinoma, and liver-related deaths. It is estimated that 40–74% of patients with hepatitis C will experience at least one extrahepatic manifestation within their lifetime. The finding of HCV-RNA sequences in post-mortem brain tissue raises the possibility that HCV infection may affect the central nervous system and be the source of subtle neuropsychological symptoms, even in non-cirrhotic. Our investigation aimed to evaluate whether asymptomatic, HCV-infected subjects showed cognitive dysfunctions. Twenty-eight untreated asymptomatic HCV subjects and 18 healthy controls were tested using three neuropsychological instruments in a random sequence: Symbol Digit Modalities Test (SDMT), Controlled Oral Word Association Test (COWAT), and Continuous Visual Attention Test (CVAT). We performed depression screening, liver fibrosis assessment, blood tests, genotyping, and HCV-RNA viral load. A MANCOVA and univariate ANCOVAS were performed to examine group differences (HCV vs. healthy controls) in four scores of the CVAT (omission errors, commission errors, reaction time—RT, and variability of RT—VRT), and the scores derived from the SDMT, and the COWAT. A discriminant analysis was performed to identify which test variables effectively discriminate HCV-infected subjects from healthy controls. There were no group differences in the scores of the COWAT, SDMT, and in two variables of the CVAT (omission and commission errors). In contrast, the performance of the HCV group was poorer than the controls in RT (p = 0.047) and VRT (p = 0.046). The discriminant analysis further indicated that the RT was the most reliable variable to discriminate the two groups with an accuracy of 71.7%. The higher RT exhibited by the HCV group may reflect deficits in the intrinsic-alertness attention subdomain. As the RT variable was found to be the best discriminator between HCV patients and controls, we suggest that intrinsic-alertness deficits in HCV patients may affect the stability of response times increasing VRT and leading to significant lapses in attention. In conclusion, HCV subjects with mild disease showed deficits in RT and intraindividual VRT as compared to healthy controls.

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Cognitive and neurophysiological assessment of patients with minimal hepatic encephalopathy in Brazil

Cited by 6 publications

References 38 publications

Is there an association between non-alcoholic fatty liver disease and cognitive function? A systematic review

Is there an association between non-alcoholic fatty liver disease and cognitive function? A systematic review

Eficacia del uso de probióticos como profilaxis en pacientes con encefalopatía hepática de cambios mínimos

Hepatitis C Virus (HCV) Infection and Neurocognitive Impairment in Subjects with Mild Liver Disease

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