Improvement in Cognitive Functioning of Alcoholics Following Orthotopic Liver Transplantation

Abstract

Cognitive functioning in alcoholic cirrhotics before and 1 year following orthotopic liver transplantation was compared with age-and sex-matched normal subjects. The alcoholic group improved significantly following transplantation on tests measuring psychomotor, visuopractic and abstracting abilities whereas the performance of normal controls remained virtually unchanged. In contrast, memory capacity in alcoholics with cirrhosis did not statistically improve following successful transplantation. Further investigation, using more sophisticated measures of memory function, are required to determine whether memory deficits are either associated with alcohol neurotoxicity or an irreversible component of hepatic encephalopathy. These findings suggest that a reversible hepatic encephalopathy underlies many of the neuropsychologic deficits observed in cirrhotic alcoholics and can be ameliorated following successful liver transplantation. KeywordsNeuropsychologlc Deficits; Hepatic Encephalopathy; Alcoholic Cirrhosis; Liver Transplantation Alcoholics commonly demonstrate a variety of neurocognitive disturbances. 1 Memory problems, abstracting deficits, visuopractic difficulties, and psychomotor inefficiency have been reported frequently in alcoholics using psychometric tests that are sensitive for detecting cerebral pathology. 2,3 Significantly, the magnitude of impairments does not correlate strongly with either the duration or intensity of alcohol abuse. 4 Furthermore, alcoholics who do not exhibit any of the medical complications frequently associated with longstanding excessive alcohol consumption typically perform normally on neuropsychologic tests. 5 The absence of covariation between the duration of alcoholism and neurocognitive impairment, combined with the observation that medically healthy alcoholics are neurologically intact, as determined by neuropsychologic test performance, suggests that factors other than chronic excessive alcohol consumption may be responsible for the manifest disturbances. Recently, the presence of a chronic low grade hepatic encephalopathy has been implicated as a major contributory factor underlying the neuropsychologic deficits. 6 Moreover, the finding that biochemical measures of hepatic injury correlate with the severity of various neuropsychological deficits detected by formal neuropsychologic testing procedures, 7 and the observation that both cirrhotic alcoholics and nonalcoholics perform Copyright © 1991 comparably on most neuropsychologic tests 8 suggests that advanced chronic liver disease is a major factor responsible for these neurologic deficits.Liver transplantation affords a unique research paradigm in which the role of subclinical hepatic encephalopathy in the pathogenesis of the neuropsychologic impairments in alcoholics can be studied. If liver injury is the principal factor responsible for the impaired cognitive functioning, vis à vis an hepatic encephalopathy, it would be expected that a return to normal neuropsychologic test performance might ensue followi...

Postoperative cognitive dysfunction after liver transplantation

“…It is well know that MHE has high prevalence in patients with liver cirrhosis, ranging from 10% to 70% [28,29,22,37]. Instead, the prevalence of POCD across the studies ranges from 0% to 50% (see Table 1).…”

Brain Morphometry and Cognitive Performance in Detoxified Alcohol-Dependents with Preserved Psychosocial Functioning

“…The medical consequences of chronic alcoholism on other organs may confound the association between brain morphometry and behavioral measures. Thus, as brain changes and cognitive deficits are partly secondary to liver damage in alcoholdependent patients with alcoholic cirrhosis (Arria et al, 1991), we selected detoxified drinkers with no clinical evidence of brain dysfunction or medical conditions considered to be clinical indicators of severe alcoholism (eg alcohol-induced dementia or chronic liver disease). Patients were included if they fulfilled the following inclusion criteria: (1) patients must have had less than three periods of withdrawal because more than two periods of withdrawal may be associated with greater cognitive impairment in alcohol-dependent subjects (Duka et al, 2003); (2) patients had to have been detoxified for at least 3 weeks and to be abstaining as assessed by biological norms (normal levels of gamma-glutamyl-transferase (GGT) and normal levels of carbohydrate-deficient transferring (CDT); and (3) they must not have taken lorazepam or sedative medication for at least 7 days.…”

Diffusion Tensor Tractography in Mesencephalic Bundles: Relation to Mental Flexibility in Detoxified Alcohol-Dependent Subjects

“…The medical consequences of chronic alcoholism on other organs may confound the association between brain microstructure and behavioral measures. Thus, as brain changes maybe, in part, secondary to liver damage in alcohol-dependent patients with alcoholic cirrhosis (Arria et al, 1991), we selected detoxified drinkers with moderate alcoholism, ie with no clinical evidence of brain dysfunction or medical conditions considered to be clinical indicators of severe alcoholism (eg alcohol-induced dementia or chronic liver disease). The inclusion criteria were (1) fewer than three periods of withdrawal because more than two periods of withdrawal may be associated with greater cognitive impairment in alcohol-dependent subjects (Duka et al, 2003), (2) detoxification for at least 3 weeks and abstinence, as assessed by normal levels of g-glutamyl-transferase and carbohydrate-deficient transferrin (see Table 2), and (3) no use of sedative medications for at least 7 days preceding the study (before participating in this study, the patients had been treated during withdrawal with decreasing doses of lorazepam and vitamins B1 and B6).…”