Abstract
Background: While neuropsychological deficits are common in patients with end stage liver disease (ESLD) evaluated for transplantation, the determinant factors are not clear. Methods: Towards that end, we examined data from 108 patients who completed neuropsychological tests as part of their liver transplantation evaluation. First, controlling for estimated premorbid ability and mood, multiple regression analyses were used to examine the effects of illness severity on cognition. Second, we compared neuropsychological functioning of patients with vs. without a history of excessive alcohol use, independent of primary liver disease diagnosis. Results: Severity of illness was associated with the extent of psychomotor slowing. Excessive alcohol use was associated with lower scores on tests of memory. Furthermore, worse memory was not explained by lower estimated premorbid ability, lower concurrently measured general intelligence, or greater illness severity. Conclusions: Our findings illustrate the importance of controlling for estimated premorbid ability in assessing the effect of illness variables on cognition. Another implication is that measures of psychomotor speed are important in assessing cognition in patients with ESLD, and especially for patients with a history of excessive alcohol use, a broader range of domains, including memory, should be examined.
Highlights
Liver disease is a major cause of death in the United States
Anxiety was significantly negatively associated with overall cognitive functioning (RBANS Total), immediate and delayed memory, and language (r’s = –0.19 to –0.27) and positively associated with TrailMaking Test (TMT)-B time (r = 0.19), suggesting greater anxiety is associated with poorer functioning on these measures
Note: aWTAR = Wechsler Test of Adult Reading; bMELD = Measure for End Stage Liver Disease; cAnxiety and Depression measured with Millon Behavioral Medicine Diagnostic; dFSIQ = Wechsler Full Scale Intelligence Quotient; eRBANS Tot = Repeatable Battery for the Assessment of Neuropsychological Status Total Score; fRBANS-IM = Immediate Memory; gRBANS-VC = Visuo-constructional; hRBANS-Lang = Language; iRBANS-Attn = Attention; jRBANS-DM = Delayed Memory; kTrails B is a measure of visuomotor speed and attention
Summary
Liver disease is a major cause of death in the United States. For example, in 2007 it was the fourth leading cause of death in people ages 45 to 54 years [1]. Both of the above studies demonstrated neuropsychological deficits in patients with ESLD, but neither study examined the effect of illness severity on cognition after controlling for estimated premorbid ability and symptoms of depression and anxiety Both studies focused on patient groups classified by primary diagnosis (e.g., alcoholic liver disease, hepatitis C with or without alcoholic liver disease, cholestatic liver disease). To the extent that chronic excessive alcohol consumption causes cognitive impairment independent of liver disease, the pattern of dysfunction in liver disease patients with vs without a history of alcohol abuse or dependence will likely differ For this reason, it is useful to assess neuropsychological functioning in ESLD patients by alcohol status independent of the primary liver disease diagnosis. Given the well-known effects of alcoholism on cognition, we anticipated that RBANS memory would be sensitive to group differences
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