Overt hepatic encephalopathy impairs learning on the EncephalApp stroop which is reversible after liver transplantation

Abstract

After an initial exposure, subjects can develop test-taking/learning strategies called the “test sophistication effect. Cirrhotics wth prior overt hepatic encephalopathy (OHE) could have persistent learning impairments. Aim To define learning/test-sophistication on EncephalApp (downloadable Application) in OHE patients compared to no-OHE patients and controls cross-sectionally and longitudinally. Methods The EncephalApp Stroop App consists of 2 sections; the easier “Off” run assesses psychomotor speed while the difficult “On” run assesses cognitive flexibility. Cross-sectional Analysis: Cirrhotic outpatients with/without controlled OHE and healthy controls underwent EncephalApp testing, which requires 5 “off” and 5 “on” runs. We studied the difference in time required between completing trial 1 compared with trial 5 (delta 1–5) in the both the “On” and “Off” runs in controls, all cirrhotics; and between prior OHE/no-OHE cirrhotics. Longitudinal Analyses: Two groups of cirrhotics were studied; one was administered EncephalApp, ≥ 2 weeks apart and the second before, and 6 months post-liver transplantation. Results 89 controls and 230 cirrhotics (85 prior OHE, MELD 11) with similar age (64 vs 61, p=0.9) were included. Cirrhotic patients had impaired EncephalApp total times and impaired learning on the On runs compared to controls. OHE patients had worse EncephalApp times and learning with the On runs compared to no-OHE patients, which persisted in the longitudinal cohort. No differences in learning were seen in the Off runs. After transplant there was restoration of learning capability with the On runs in the OHE patients. Conclusion Cognitive flexibility tested by the EncephalApp On runs improves over time in healthy controls and no-OHE but not prior OHE. Psychomotor speed remains similar over time. The learning Impairment manifested by cirrhotics with OHE is restored post-transplant.

Use of the Stroop Encephalapp for Covert Hepatic Encephalopathy Screening in Cirrhotic Patients in Southern Brazil

“…Considering this fact, a learning curve may be considered for the reproducibility of the test in order to avoid high rates of false positives as found in our study (50.9%). A previous study had already shown that repeating the test at regular intervals of time is capable of providing better results among cirrhotic patients with no history of CHE (19) ; a similar follow-up in our patients would certainly show the veracity or not of the false positives for the Stroop test. Furthermore, both Stroop and PHES tests aim to evaluate the neurocognitive performance of the patients.…”

Cognitive Function in Liver Transplant Recipients Who Survived More Than 6 Months

“…Previous studies in recipients within 18 months posttransplant have documented impairment in visuospatial and executive function. 23 Another cross-sectional study, which examined the cognitive function of 12 liver transplant recipients who survived more than 10 years, also documented the impairment in visuospatial and executive function. 24 Considering the mean time elapsed since transplantation of participants in this study was 7.6 years, our findings suggest that visuospatial and executive function may be part of long-term cognitive decline among individuals with a liver transplant.…”

High‐Fat Diet Modulates Hepatic Amyloid β and Cerebrosterol Metabolism in the Triple Transgenic Mouse Model of Alzheimer’s Disease

“…Alterations of the liver–brain axis have been described in liver diseases such as viral hepatitis and liver failure, which lead to a large spectrum of neurological abnormalities. ( 27,28 ) Cognitive impairment in these diseases worsens with age, but significantly improves after liver transplantation, ( 29 ) strengthening the role of the liver in neurological alterations. Numerous reports have emerged describing patients with NAFLD or animal models with cerebral dysfunction and neuropathology similar to AD.…”