A New Score Unveils a High Prevalence of Mild Cognitive Impairment in Patients with Nonalcoholic Fatty Liver Disease.

Carla Giménez-Garzó,Desamparados Escudero-García,Luis Aparicio,Lucía Durbán,Salvador Benlloch,María-Pilar Ballester-Ferré,Amparo Urios,Juan-José Gallego,María-Pilar Ríos,Joan Tosca,David Martí-Aguado,Carmina Montoliu,Alessandra Fiorillo,Franc Casanova-Ferrer,Teresa San-Miguel,Vicente Felipo,Cristina Montón

doi:10.3390/jcm10132806

Abstract

Patients with nonalcoholic fatty liver disease (NAFLD) may show mild cognitive impairment (MCI). The neurological functions affected remain unclear. The aims were to: (1) Characterize the neuropsychological alterations in NAFLD patients; (2) assess the prevalence of impairment of neurological functions evaluated; (3) develop a new score for sensitive and rapid MCI detection in NAFLD; (4) assess differences in MCI features between patients with nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH); and (5) compare neuropsychological alterations in NAFLD patients with cirrhotic patients with MCI. Fifty-nine NAFLD patients and 53 controls performed psychometric tests assessing different neurological functions: PHES (Psychometric Hepatic Encephalopathy Score) battery, d2, Stroop, Oral SDMT (Symbol Digit Modalities Test), Digit Span, number-letter test, and bimanual and visual-motor coordination tests. NAFLD patients show impairment in attention, mental concentration, psychomotor speed, cognitive flexibility, inhibitory mental control, and working memory. We developed a new, rapid, and sensitive score based on the most affected parameters in NAFLD patients, unveiling that 32% of NAFLD show MCI. Prevalence was similar in NAFL (36%) or NASH (27%) patients, but lower in NAFLD than in cirrhosis (65%). MCI prevalence is significant in NAFLD patients. Psychometric testing is warranted in these patients to unveil MCI and take appropriate measures to reverse and prevent its progression.

Highlights

Licensee MDPI, Basel, Switzerland.Nonalcoholic fatty liver disease (NAFLD) is the primary cause of liver disease and is characterized by hepatic steatosis not attributable to the consumption of alcohol, long-term use of steatogenic medication, or monogenic hereditary disorders
nonalcoholic fatty liver disease (NAFLD) patients show a significant increase in total errors (O + C) compared to controls (Table 2)
The results obtained in the d2 test indicate that NAFLD patients show impaired selective/sustained attention and mental concentration, speed and amount of work done, accuracy of this work, and relationship between speed and accuracy

Summary

Introduction

Nonalcoholic fatty liver disease (NAFLD) is the primary cause of liver disease and is characterized by hepatic steatosis not attributable to the consumption of alcohol, long-term use of steatogenic medication, or monogenic hereditary disorders. NAFLD prevalence is increasing as a consequence of obesity, many patients are lean. From South America and the Middle East, followed by Asia, the USA, and Europe [3], and incidence is expected to continue rising in parallel with obesity, diabetes, and other lifestyle-related diseases [4]. NAFLD can be classified as nonalcoholic fatty liver (NAFL) or nonalcoholic steatohepatitis (NASH). NAFL is defined as the presence of ≥5% hepatic steatosis without hepatocellular injury. NASH is defined as the presence of ≥5% hepatic steatosis and inflammation with hepatocyte injury (e.g., ballooning), with or without fibrosis [1], and has an estimated prevalence of around 3–6%

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