Abstract
Minimal hepatic encephalopathy (MHE) is associated with mild cognitive impairment and frailty. This study aims to identify cognitive and motor differences in cirrhotic patients with and without MHE, and the correlations between motor signs and cognitive performance. Gait, balance, hand strength and motor speed performance were evaluated in 66 cirrhotic patients (38 without and 28 with MHE, according to the Psychometric Hepatic Encephalopathy Score (PHES). Cognitive performance was measured with the Mini-Mental State Examination, Verbal Fluency Test, Aprendizaje Verbal España-Complutense Test (TAVEC), Wechsler Adult Intelligence Scale III, Hamilton Depression and Anxiety Rating Scale and Functioning Assessment Short Test (FAST). MHE patients performed worse than patients without MHE in cognitive and autonomous functioning, learning and long-term memory, and verbal fluency. The same pattern was found in gait, center of pressure movement, variability of hand strength performance and hand motor speed. In MHE patients, high correlations were found between balance and FAST test, gait velocity and verbal skills, hand strength variability and anxiety and depression, and motor speed and FAST and TAVEC. MHE patients showed worse motor and cognitive performance than patients without MHE. MHE patients could have impaired movement control expressed as bradykinesia, and this reduced motor performance could correlate with cognitive performance.
Highlights
Liver cirrhosis is associated with multiple complications, the most serious of which is hepatic encephalopathy (HE) [1,2], a common reason for hospital admission [3]
Sample size was calculated considering biochemical variables (3-nitrotyrosine) that discriminate between cirrhotic patients with and without minimal hepatic encephalopathy (MHE), as well as resonance parameters obtained in previous studies and that presented less power of discrimination than 3-nitrotyrosine [17,18]
We studied outcomes of the Romberg test with the most unstable condition: (1) center of pressure (COP) displacement angle: displacement vector orientation (◦) extending from the starting point to the end position of the subject; (2) total COP displacement: total distance of the COP reached from the origin; (3) anterior–posterior COP displacement: maximum anterior–posterior distance reached by COP during the test; (4) mediolateral COP displacement: maximum mediolateral distance reached by COP during the test and (5) COP swept area: area of subject’s swing, calculated from beginning until end of the test [32]
Summary
Liver cirrhosis is associated with multiple complications, the most serious of which is hepatic encephalopathy (HE) [1,2], a common reason for hospital admission [3]. Ney et al aimed to determine a specific cognitive and physical profile in these patients with the ultimate goal of identifying early markers of progressive deterioration [6] These authors described a composite score from the Montreal Cognitive Assessment and the Clinical Frailty Scale to predict hospital admission of HE patients at six months [6]. Motor evaluations like clinical tests or scales have certain limitations, as results can be biased by evaluator subjectivity or inaccurate patient reporting In this regard, including the motor sign assessment in the study of early indicators in MHE patients is a step forward, insofar as biomechanical tools allow researchers to check objective measures of frailty. There seems to be motor differentiation between patients with and without MHE, to our best knowledge no studies have assessed motor performance with biomechanics tools, or which specific cognitive domains, related to motor disturbances, can discern between cirrhotic patients with and without MHE
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