Disrupted Brain Intrinsic Networks and Executive Dysfunction in Cirrhotic Patients without Overt Hepatic Encephalopathy

Abstract

Objective: Patients with cirrhosis often exhibit cognitive deficits, particularly executive dysfunction, which is considered a predictor of overt hepatic encephalopathy (OHE). We examined brain intrinsic networks associated with executive function to investigate the neural basis of this cognitive deficiency in cirrhosis. Methods:Resting-state functional MRI data were acquired from 20 cirrhotic patients and 18 healthy controls. Seed-based correlation analysis was used to identify the three well-known networks associated with executive function, including executive control (ECN), default mode (DMN), and salience (SN) networks. Functional connectivity (FC) within each network was compared between groups and correlated with patient executive performance (assessed by the Stroop task).results: Patients showed decreased FC between the ECN seed (right dorsolateral prefrontal cortex) and several regions (including right middle/inferior frontal gyrus, left inferior frontal gyrus, bilateral inferior/superior parietal lobules, bilateral middle/inferior temporal gyrus, and right medial frontal gyrus), between the DMN seed [posterior cingulate cortex (PCC)] and several regions (including bilateral medial frontal gyrus, bilateral anterior cingulate cortex, bilateral superior frontal gyrus, bilateral precuneus/PCC, left supramarginal gyrus, and left middle temporal gyrus), and between the SN seed (right anterior insula) and right supramarginal gyrus. FC strength in the ECN and SN was negatively correlated with patient performance during the Stroop task.conclusion: Disrupted functional integration in the core brain cognitive networks, which is reflected by reductions in FC, occurs before OHE bouts and may play an important role in the neural mechanism of executive dysfunction associated with cirrhosis.

Pitch Processing Can Indicate Cognitive Alterations in Chronic Liver Disease: An fNIRS Study

“…Given that CIT1 and CIT2 involve auditory selective attention and that CIT3 involves auditory alternating attention, the cognitive threshold of patients with CLD might be auditory alternating attention (or cognitive flexibility). The current findings resembled previous findings where selective attention (Felipo et al, 2012 ) and cognitive flexibility (Yang et al, 2018 ) deteriorated in patients with liver-related diseases. The tasks employed in the previous studies are visual-oriented, so our findings revealed that the deterioration of selective attention and of cognitive flexibility exists similarly in an auditory modality.…”

Removal of Interictal MEG-Derived Network Hubs Is Associated With Postoperative Seizure Freedom

“…Our approach builds on our previous work with intracranial EEG, where we show that patients generally have better seizure outcomes when high-strength nodes are surgically removed (27)(28)(29)(30). Other groups have reported similar findings from intracranial EEG (31)(32)(33)(34)(35)(36)(37). With MEG data, Nissen et al (9) showed in a cohort of 22 patients, that interictal source localized network hubs overlapped with the resection in seizure-free patients only.…”

Altered Topological Properties of Gray Matter Structural Covariance Networks in Minimal Hepatic Encephalopathy

“…MHE patients had fewer hubs than those in the HC group (15 vs. 17) and showed a different distribution of network hubs from the HC group. They lost hub nodes mainly from the bilateral frontal lobe, right parietal lobe, as well as the left insular cortex, which are areas that are most frequently affected in MHE (Hsu et al, 2012 ; Zhang et al, 2012 ; Chen et al, 2013 ; Yang et al, 2018 ). Thus, our finding further indicated the selective vulnerability of these areas in the case of MHE.…”