Non invasive blood flow measurement in cerebellum detects minimal hepatic encephalopathy earlier than psychometric tests

Felipo, Vicente; Urios, Amparo; Giménez-Garzó, Carla; Cauli, Omar; Andrés-Costa, Maria-Jesús; González, Olga Martínez; Serra, Miguel; Sánchez‐González, Javier; Aliaga, Roberto; Giner‐Durán, Remedios; Belloch, Vicente; Montoliú, Carmina

doi:10.3748/wjg.v20.i33.11815

Cited by 38 publications

(36 citation statements)

References 41 publications

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“…Interestingly, the cerebellar blood flow is increased in cirrhotic patients, and specifically elevated in the vermis of MHE group. These alterations in blood flow correlate negatively with the execution of the NCT-A and B of PHES [6]. Alterations in GM volume in cerebellum, along with alterations in blood flow, could explain the impairment in executive function and cognitive processing speed in patients evaluated through the performance of such PHES subtests.…”

Section: Discussionmentioning

confidence: 99%

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Reduced resting state connectivity and gray matter volume correlate with cognitive impairment in minimal hepatic encephalopathy

García‐García¹,

Cruz-Gómez²,

Mangas‐Losada³

et al. 2017

PLoS ONE

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Background and aimsMinimal hepatic encephalopathy (MHE) is associated with cognitive alterations and changes in connectivity. We assessed the relationship of the abnormalities of resting-state functional connectivity (rs-FC) and gray matter (GM) volume with different cognitive alterations and biochemical parameters associated to MHE.MethodsThirty-nine cirrhotic patients (26 without and 13 with MHE) and 24 controls were widely cognitive assessed with a battery of psychometric tests. Atrophy was determined using Voxel-Based Morphometry and rs-FC was assessed by independent component analysis. Receiver operating characteristic (ROC) curves was performed to assess the diagnostic utility of rs-FC and GM reduction for the discrimination of patients with and without MHE. Blood ammonia, cGMP, and levels of pro-inflammatory interleukins were measured.ResultsMHE patients showed significant decrease of GM volume and lesser degree of rs-FC in different networks related to attention and executive functions as compared to controls and patients without MHE. There is a progressive reduction in rs-FC in the default mode network with the progression of cognitive impairment. MHE patients showed GM reduction in the right frontal lobe, right insula and right cerebellum compared to patients without MHE. Alterations in GM volume and rs-FC correlated with the scores of different cognitive tests.ConclusionsDecreased cognitive performance is associated by reduced rs-FC and GM atrophy in MHE patients. These changes could have predictive value for detecting MHE.

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Section: Discussionmentioning

confidence: 99%

“…Around 33–50% of cirrhotic patients without clinical symptoms of HE show minimal hepatic encephalopathy (MHE) with mild cognitive impairment, attention deficits [3,4] and impaired visuo-motor and bimanual coordination [5, 6]. MHE decreases the quality of life, and increases the probability of suffering HE [7, 8].…”

Section: Introductionmentioning

confidence: 99%

Reduced resting state connectivity and gray matter volume correlate with cognitive impairment in minimal hepatic encephalopathy

García‐García¹,

Cruz-Gómez²,

Mangas‐Losada³

et al. 2017

PLoS ONE

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“…Felipo et al found that determining noninvasive brain blood flow using arterial spin labeling (ASL) could detect MHE earlier than Psychometric Hepatic Encephalopathy Score (PHES) [32] indicating there are early changes to cerebral hemodynamics in the preliminary stages of HE. In the present study, prior to treatment, we observed no differences in V p ( P = 0.356) of right MCA, while significant differences were evident in V m , V d , PI, and RI ( P < 0.05).…”

Section: Discussionmentioning

confidence: 99%

Cerebral Hemodynamics and Cognitive Function in Cirrhotic Patients with Hepatic Encephalopathy

Zhou

Dong

Zhang

et al. 2016

Gastroenterology Research and Practice

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Aims. To investigate cerebral hemodynamics in cirrhotic patients with HE and to observe effects of treatment in cerebral hemodynamics and correlations among ammonia, cerebral hemodynamics, and cognitive function. Methods. There were four groups: healthy controls (group 1), cirrhosis without HE (group 2), cirrhosis with MHE (group 3), and cirrhosis with OHE (group 4). Ammonia and cerebral hemodynamics (by TCD) were assessed. Patients in group 3 were subsequently randomized to two subgroups: the control (group A) and the treated (group B, treated with lactulose for two months), and they were retested for ammonia and TCD after treatment. Results. Ammonia, Vm, Vd, PI, and RI were statistically different before treatment, and ammonia, PI, and RI levels paralleled the severity of HE (P < 0.05). In group B, Vd increased and ammonia, PI, and RI declined following treatment (P < 0.05), while there were no differences in group A (P > 0.05). Correlations were found between ammonia and Vd, PI, RI, NCT-A, and DST and also found between Vd, PI, RI, and NCT-A and DST (P < 0.05). Conclusions. This study revealed that cerebral hemodynamics were related to the severity of HE and cerebral autoregulation was impaired. There were tight correlations among ammonia, cerebral hemodynamics, and cognitive function, and, following treatment, cerebral hemodynamics improved.

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“…39 We have previously shown that cerebral blood flow, measured by arterial spin labelling, is increased selectively in the cerebellar vermis and reduced in the occipital lobe in patients with MHE compared with patients without MHE, and that blood flow in cerebellar vermis is predictive for MHE. 40 These alterations could contribute to impairment in postural control of patients with MHE. Hyperammonaemia acts synergistically with inflammation to induce MHE.…”

Section: Discussionmentioning

confidence: 99%

Altered postural control and stability in cirrhotic patients with minimal hepatic encephalopathy correlate with cognitive deficits

Urios

Mangas‐Losada

Giménez-Garzó

et al. 2017

Liver International

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Non invasive blood flow measurement in cerebellum detects minimal hepatic encephalopathy earlier than psychometric tests

Abstract: Non invasive BF determination in cerebellum using ASL may detect MHE earlier than the PHES. Altered NO-cGMP pathway seems to be associated to altered BF in cerebellum.

Cited by 38 publications

References 41 publications

Reduced resting state connectivity and gray matter volume correlate with cognitive impairment in minimal hepatic encephalopathy

Reduced resting state connectivity and gray matter volume correlate with cognitive impairment in minimal hepatic encephalopathy

Cerebral Hemodynamics and Cognitive Function in Cirrhotic Patients with Hepatic Encephalopathy

Altered postural control and stability in cirrhotic patients with minimal hepatic encephalopathy correlate with cognitive deficits

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