Minimal Hepatic Encephalopathy Is Associated With Falls

Román, Eva; Córdoba, Joan; Torrens, M.; Torras, Xavier; Villanueva, Càndid; Vargas, Vı́ctor; Guarner, Carlos; Soriano, Germán

doi:10.1038/ajg.2010.413

Cited by 195 publications

(211 citation statements)

References 43 publications

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“…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.…”

Section: Falls In Minimal Hepatic Encephalopathymentioning

confidence: 99%

“…Risk is increased further in patients taking psychoactive drugs. 76 Increased risk of falls in MHE patients is due to impaired attention and visuomotor coordination and slowed reaction time and psychomotor speed. Increased number of falls and associated osteoporosis predisposes to these patients to increased risk of fractures [78][79][80] and associated surgery which leads on to significant morbidity, decompensation and mortality.…”

Section: Falls In Minimal Hepatic Encephalopathymentioning

confidence: 99%

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Minimal Hepatic Encephalopathy Impairs Quality of Life

Agrawal

Umapathy

Dhiman

2015

Journal of Clinical and Experimental Hepatology

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Minimal hepatic encephalopathy (MHE) is the mildest form of the spectrum of neurocognitive impairment in cirrhosis. It is a frequent occurrence in patients of cirrhosis and is detectable only by specialized neurocognitive testing. MHE is a clinically significant disorder which impairs daily functioning, driving performance, work capability and learning ability. It also predisposes to the development of overt hepatic encephalopathy, increased falls and increased mortality. This results in impaired quality of life for the patient as well as significant social and economic burden for health providers and care givers. Early detection and treatment of MHE with ammonia lowering therapy can reverse MHE and improve quality of life. ( J CLIN EXP HEPATOL 2015;5:S42-S48) H epatic encephalopathy (HE) is a neurocognitive disorder in which brain function is impaired and is associated with both acute and chronic liver dysfunction. 1 It is a major complication that develops in some form and at some stage in a majority of patients with liver cirrhosis. Minimal HE (MHE) is the mildest form of spectrum of HE which is characterized by subtle cognitive and psychomotor deficits in the absence of recognizable clinical symptoms of HE. 2 It occurs in patients with liver dysfunction and/or portosystemic shunts. In MHE, neurocognitive abnormalities primarily affect attention, speed of information processing, executive control, motor ability and coordination in an individual. 3 In 1970, Zeegen et al 4 first described this condition when they discovered that 38% of patients who had undergone portal decompression surgery scored abnormal in Reitan trail making test (number connection test). Eight years later, the term subclinical HE 5 was introduced to describe these patients. Since then, this condition was described under various names like early HE, latent HE, subclinical HE and finally minimal HE. The latest classification combines MHE and grade 1 HE into covert HE while higher grades are classified as overt HE, thus simplifying the clinical schema so that HE can be uniformly diagnosed. 6 Covert HE means that the mental defect is not detectable by the clinician using conventional testing and is not noticeable to the patient. However, it is significant because these patients usually have neuropsychiatric and neurophysiological abnormalities on advanced testing which are not enough to cause disorientation or asterixis. MHE is regarded as a preclinical stage of HE and ammonia and systemic inflammation plays an important role in its pathogenesis similar to HE. Ammonia lowering therapies were used in the treatment of MHE and found to be effective.MHE is clinically significant as it impairs daily functioning, health related quality of life (HRQOL) and driving skills, predicts the development of overt HE and is associated with poor survival. 7-11 Overt HE develops in >50% of MHE patients within three years. 10 These patients pose a significant burden to their care givers depending on the severity of cognitive dysfunction. 2,12 Considering all ...

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Section: Falls In Minimal Hepatic Encephalopathymentioning

confidence: 99%

Section: Falls In Minimal Hepatic Encephalopathymentioning

confidence: 99%

Minimal Hepatic Encephalopathy Impairs Quality of Life

Agrawal

Umapathy

Dhiman

2015

Journal of Clinical and Experimental Hepatology

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“…64,65 Studies have consistently shown that patients with MHE have a diminished quality of life, cognitive function, daily function, and driving impairment. [3][4][5][6][7][8][9][10] While it was once thought that cognitive impairment with CHE or OHE was reversible, data from studies evaluating medical treatment or liver transplantation suggest that the associated cognitive changes may not be totally reversible. [66][67][68] Moreover, it has been demonstrated that even after therapy and improvement to normal mental status, a single episode of OHE may continue to have residual negative effects on cognitive function.…”

Section: Management Guidelines For Covert Hepatic Encephalopathymentioning

confidence: 99%

“…Over the last decade, there is compelling evidence that MHE has a negative impact on quality of life and patient well being. [3][4][5][6][7][8][9][10] However, the natural history of CHE and the effect of treatment on the overall prognosis of CHE requires further long-term studies.…”

Section: Management Guidelines For Covert Hepatic Encephalopathymentioning

confidence: 99%

“…2 Prior terminology included "sub-clinical", "latent", and "minimal" appear to trivialize the condition. There is abundant evidence in the literature that MHE has a profound impact on quality of life, daily functioning, driving ability, [3][4][5][6][7][8][9][10] and nearly half of all patients with MHE may be unfit to maintain employment. 9 Based on the current ISHEN guidelines, 11 patients with MHE and Grade I encephalopathy by WestHaven Criteria were re-classified as having covert hepatic encephalopathy (CHE).…”

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confidence: 99%

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Management of Covert Hepatic Encephalopathy

Mullen

Prakash

2012

Clinics in Liver Disease

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Diagnosis and Management of Cirrhosis and Its Complications

Tapper

Parikh

2023

JAMA

103

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ImportanceCirrhosis affects approximately 2.2 million adults in the US. From 2010 to 2021, the annual age-adjusted mortality of cirrhosis increased from 14.9 per 100 000 to 21.9 per 100 000 people.ObservationsThe most common causes of cirrhosis in the US, which can overlap, include alcohol use disorder (approximately 45% of all cases of cirrhosis), nonalcoholic fatty liver disease (26%), and hepatitis C (41%). Patients with cirrhosis experience symptoms including muscle cramps (approximately 64% prevalence), pruritus (39%), poor-quality sleep (63%), and sexual dysfunction (53%). Cirrhosis can be diagnosed by liver biopsy but may also be diagnosed noninvasively. Elastography, a noninvasive assessment of liver stiffness measured in kilopascals, can typically confirm cirrhosis at levels of 15 kPa or greater. Approximately 40% of people with cirrhosis are diagnosed when they present with complications such as hepatic encephalopathy or ascites. The median survival time following onset of hepatic encephalopathy and ascites is 0.92 and 1.1 years, respectively. Among people with ascites, the annual incidence of spontaneous bacterial peritonitis is 11% and of hepatorenal syndrome is 8%; the latter is associated with a median survival of less than 2 weeks. Approximately 1% to 4% of patients with cirrhosis develop hepatocellular carcinoma each year, which is associated with a 5-year survival of approximately 20%. In a 3-year randomized clinical trial of 201 patients with portal hypertension, nonselective β-blockers (carvedilol or propranolol) reduced the risk of decompensation or death compared with placebo (16% vs 27%). Compared with sequential initiation, combination aldosterone antagonist and loop diuretics were more likely to resolve ascites (76% vs 56%) with lower rates of hyperkalemia (4% vs 18%). In meta-analyses of randomized trials, lactulose was associated with reduced mortality relative to placebo (8.5% vs 14%) in randomized trials involving 705 patients and reduced risk of recurrent overt hepatic encephalopathy (25.5% vs 46.8%) in randomized trials involving 1415 patients. In a randomized clinical trial of 300 patients, terlipressin improved the rate of reversal of hepatorenal syndrome from 39% to 18%. Trials addressing symptoms of cirrhosis have demonstrated efficacy for hydroxyzine in improving sleep dysfunction, pickle brine and taurine for reducing muscle cramps, and tadalafil for improving sexual dysfunction in men.Conclusions and RelevanceApproximately 2.2 million US adults have cirrhosis. Many symptoms, such as muscle cramps, poor-quality sleep, pruritus, and sexual dysfunction, are common and treatable. First-line therapies include carvedilol or propranolol to prevent variceal bleeding, lactulose for hepatic encephalopathy, combination aldosterone antagonists and loop diuretics for ascites, and terlipressin for hepatorenal syndrome.

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Minimal Hepatic Encephalopathy Is Associated With Falls

Abstract: Falls are more frequent in cirrhotic patients with MHE, particularly in those on treatment with psychoactive drugs, and are a significant cause for healthcare and hospitalization requirements.

Cited by 195 publications

References 43 publications

Minimal Hepatic Encephalopathy Impairs Quality of Life

Minimal Hepatic Encephalopathy Impairs Quality of Life

Management of Covert Hepatic Encephalopathy

Diagnosis and Management of Cirrhosis and Its Complications

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