Cognitive dysfunction in cirrhosis is associated with falls: A prospective study

Abstract

Falls are frequent among patients with debilitating disorders and can have a serious effect on health status. Mild cognitive disturbances associated with cirrhosis may increase the risk for falls. Identifying subjects at risk may allow the implementation of preventive measures. Our aim was to assess the predictive value of the Psychometric Hepatic Encephalopathy Score (PHES) in identifying patients likely to sustain falls. One hundred and twenty-two outpatients with cirrhosis were assessed using the PHES and were followed at specified intervals. One third of them exhibited cognitive dysfunction (CD) according to the PHES (<24). Seventeen of the forty-two patients (40.4%) with CD had at least one fall during follow-up. In comparison, only 5 of 80 (6.2%) without CD had falls (P < 0.001). Fractures occurred in 4 patients (9.5%) with CD, but in no patients without CD (P 5 0.01). Patients with CD needed more healthcare (23.8% versus 2.5%; P < 0.001), more emergency room care (14.2% versus 2.5%; P 5 0.02), and more hospitalization (9.5% versus 0%; P 5 0.01) as a result of falls than patients without CD. Patients taking psychoactive treatment (n 5 21) had a higher frequency of falls, and this was related to an abnormal PHES. In patients without psychoactive treatment (n 5 101), the incidence of falls was 32.4% in patients with CD versus 7.5% in those without CD (P 5 0.003). In the multivariate analysis, CD was the only independent predictive factor of falls (odds ratio, 10.2; 95% confidence interval, 3.4-30.4; P < 0.001). The 1-year probability of falling was 52.3% in patients with CD and 6.5% in those without (P < 0.001). Conclusion: An abnormal PHES identifies patients with cirrhosis who are at risk for falls. This psychometric test may be useful to promote awareness of falls and identify patients who may benefit from preventive strategies. (HEPATOLOGY 2012;55:1922-1930

Helicobacter pylori induced cognitive dysfunction might be associated with falls and fractures in cirrhosis

“…1 We agree with these authors that subclinical cognitive dysfunction in cirrhosis is a multifactorial issue. Although minimal hepatic encephalopathy plays a key role in such dysfunction, other factors, such as etiology of cirrhosis, comorbidities, or psychoactive treatments, can also be implicated.…”

“…In their prospective series, Soriano et al 1 concluded that cognitive dysfunction (CD) is a factor associated with falls in patients with cirrhosis, and further studies are warranted to address the mechanisms implicated in this predisposition and to design preventive strategies.…”

“…Apart from CD causes that can be the result of multiple issues, including the etiology of cirrhosis, mentioned by the authors, 1 Helicobacter pylori infection (Hp-I) appears to be a common denominator associated with CD-related falls and fractures and liver cirrhosis. [2][3][4] In this respect, we reported that Hp-I is frequently detected in neurodegenerative diseases including CD and Alzheimer's disease (AD) and Hp eradication may positively influence AD manifestations at 2-and 5-year clinical endpoints, 2 thereby supporting a role for this common infection in the pathobiology of the disease.…”

“…Although minimal hepatic encephalopathy plays a key role in such dysfunction, other factors, such as etiology of cirrhosis, comorbidities, or psychoactive treatments, can also be implicated. [1][2][3] Multiple factors are also involved in the risk of falling. 4 1284 CORRESPONDENCE HEPATOLOGY, March 2013…”

Minimal Hepatic Encephalopathy Impairs Quality of Life

“…MHE is associated with increased risk of falls 76,77 which result in reduced quality of life. While 12% of patients without MHE had falls, almost 40% of patients with MHE had falls resulting in an increased need for hospitalization.…”