Abstract
ContextChronic infection by hepatitis C virus causes impairment in neurocognitive function in up to 50% of patients which may not be detected by clinical tests.AimEarly detection of neurocognitive impairment in chronic hepatitis C patients and investigating the cognitive function in HCV patient by p300 and clinical test.Materials and methodsThe study included 60 patients with chronic hepatitis C and 30 healthy controls. Participants were subjected to a biochemical, hematological assessment, mini-mental state examination, Montreal Cognitive Assessment, P300, polymerase chain reaction (PCR), and fibroscan made for hepatitis C patients.ResultsThe digit span, attention, concentration, and memory were significantly lower in patients than controls. The delayed P300 peak latency and the reduction of its amplitude were significantly evident in patients with liver fibrosis than the controls and patients without fibrosis. These abnormalities were significantly higher with increasing the grade of fibrosis. All patients with cognitive impairment (reduced mini-mental state score) had abnormal P300-evoked responses. P300 could detect neurocognitive impairment in some patients with normal neurocognitive functions by clinical test. P300 had sensitivity (100%), specificity (59.26), positive predictive value (75%), negative predictive value (100%), and accuracy (81.67) in the detection of neurocognitive impairment in HCV patient.ConclusionPatients with chronic hepatitis C infection had significant impairment in their cognitive functions. This impairment increases with the increase in grade of hepatic fibrosis. P300 can detect minimal and subclinical impairment of cognitive function at early stages of chronic hepatitis with accuracy (81.67).Trial registrationPACTR on 19 march 2018 retrospectively. Identification number for the registry is PACTR201804003215168.
Highlights
Hepatitis C virus (HCV) infection is a serious global health problem that affects 180 million people worldwide
The delayed P300 peak latency and the reduction of its amplitude were significantly evident in patients with liver fibrosis than the controls and patients without fibrosis
We found that the frequency of delayed P300 peak latency was increased in the three groups of chronic hepatitis than controls (P = 0.029) and that the delay of P300 peak latency and reduction of P300 amplitude were significantly evident in F2 and F3 groups than control group while F0-F1 showed delay in latency of P300 and reduction in amplitude of P300 than control but they were statistically not significant
Summary
Hepatitis C virus (HCV) infection is a serious global health problem that affects 180 million people worldwide. Symptoms of brain dysfunction such as fatigue and depression are frequent in patients with chronic hepatitis C than in chronic hepatitis B, and these symptoms improved after clearing the virus with treatment [2]. Forton et al [6] compared cognitive function in individuals with HCV viremia and those with only anti-HCV antibodies. He found that HCV-infected patients were impaired on more cognitive tasks than the HCV-cleared group and viremic individuals showed specific impairment in power of concentration and speed of working memory [6]. Cognitive deficits may be found in HCV (hepatitis c virus) patients even prior to the development of cirrhosis and liver dysfunction [2]. P300-evoked response is an objective and independent measure of cerebral information processing to avoid the potential bias of fatigue, latent depression, or impaired self-rating in psychometric assessment [7]
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