Abstract
Cognition was assessed in hepatitis C virus (HCV) patients, who did not meet the criteria for a minimal hepatic encephalopathy. Their liver function was compensated. We then disentangled potential cognitive changes associated with a sustained virologic response at 12 weeks (SVR-12), following treatment with direct antiviral agents (DAAs). We studied 23 selected HCV patients with a battery of standard neuropsychological tests, and with recordings of the P300 wave, a cerebral potential of “cognitive” significance. There was a baseline evaluation (T0) and a second one 6 months later (T1). We had 2 control groups of comparable age and sex, i.e., 15 patients suffering from non-alcoholic fatty liver disease (NAFLD) and 15 healthy subjects. At T0, we detected a significant (p < 0.05) cognitive impairment in the HCV group, which involved episodic and working memory, attention, visuospatial and verbal abilities, executive functions, and logic reasoning. The P300 latency was significantly (p < 0.05) delayed in the group. At T1, we observed some significant (p < 0.05) HCV recovery in given test domains, e.g., memory, executive functions, and reasoning. Accordingly, the P300 latency shortened significantly (p < 0.05). HCV patients exhibited subtle cognitive defects, somehow independent of their liver condition, possibly linked to direct or indirect brain involvement by the virus. These defects partly recovered following the SVR-12, as achieved through DAAs. The P300 wave was a valid neurophysiologic counterpart of these changes. DAAs can have a role in the early preservation of cognition in HCVs.
Highlights
Hepatic encephalopathy (HE) and its mildest expression are a neuropsychiatric syndrome related to liver failure, with a wide range of severity (Wijdicks 2016)
Considering patients with liver disease, the BMI and the albumin level were significantly higher in the non-alcoholic fatty liver disease (NAFLD) than in the hepatitis C virus (HCV) subgroup, while the reverse was true for AST and ALT measures (Table 1, for p values)
If contrasted to the NAFLD group, HCV patients performed significantly worse on the Psychometric Hepatic Encephalopathy Score (PHES), the RAVLT, and the verbal judgment test, and on the Rey Complex Figure Delayed and the Semantic Verbal Fluency tests
Summary
Hepatic encephalopathy (HE) and its mildest expression (minimal HE) are a neuropsychiatric syndrome related to liver failure, with a wide range of severity (Wijdicks 2016). Hepatitis C virus (HCV) patients not even meeting the definition(s) of minimal HE (Weissenborn 2015) can show a subtle cognitive impairment. This picture, termed HCVassociated neurocognitive disorder (HCV-AND) affects for instance attention, executive functions, learning/visuospatial. Several studies after HCV eradication showed improvement in quality of life or mood, and in reaction time (Thein et al 2007), verbal memory and visuospatial ability (Byrnes et al 2012), and working memory (Kraus et al 2013). Some authors questioned any actual improvement, and the whole topic is somehow controversial (Dirks et al 2017)
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