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Hepatic Encephalopathy Is Associated with Persistent Learning Impairments Despite Adequate Medical Treatment: A Multicenter, International Study.

Authors :
Nardelli, Silvia
Allampati, Sanath
Riggio, Oliviero
Mullen, Kevin
Prakash, Ravi
Gioia, Stefania
Unser, Ariel
White, Melanie
Fagan, Andrew
Wade, James
Farcomeni, Alessio
Gavis, Edith
Bajaj, Jasmohan
Mullen, Kevin D
White, Melanie B
Fagan, Andrew C
Wade, James B
Gavis, Edith A
Bajaj, Jasmohan S
Source :
Digestive Diseases & Sciences; Mar2017, Vol. 62 Issue 3, p794-800, 7p
Publication Year :
2017

Abstract

<bold>Background: </bold>Hepatic encephalopathy (HE) is considered reversible regarding mental status but may not be cognitively in single-center studies.<bold>Aim: </bold>To evaluate persistence of learning impairment in prior HE compared to those who never experienced HE (no-HE) in a multicenter study.<bold>Methods: </bold>A total of 174 outpatient cirrhotics from three centers (94 Virginia, 30 Ohio, and 50 Rome; 36 prior HE) underwent psychometric hepatic encephalopathy score (PHES) and inhibitory control (ICT) testing at baseline and then at least 7 days apart. ICT learning (change in 2nd half lures compared to 1st half) was compared between patient groups at both visits. Change in the PHES individual sub-tests and total score between visits was compared in both groups. US versus Italian trends were also analyzed.<bold>Results: </bold>HE patients had worse PHES and ICT results compared to no-HE patients at baseline. Significant improvement (1st half 7.1 vs. 2nd half 6.2, p < 0.0001) was observed in no-HE, but not in HE (1st half 7.9 vs. 2nd half 7.8, p = 0.1) at baseline. At retesting (median 20 days later), no-HE patients continued with significant learning (1st half 6.0 vs. 2nd half 5.4, p < 0.0001), while HE patients again did not improve (1st half 7.8 vs. 2nd half 6.9, p = 0.37). Between visits, no-HE patients improved significantly on four PHES sub-tests and overall score, while HE patients only improved on two sub-tests with similar overall PHES score. Trends were similar between US and Italian subjects.<bold>Conclusion: </bold>In this multicenter study, prior HE patients showed persistent significant learning impairment compared to those without prior HE, despite adequate medical therapy. This persistent change should increase efforts to reduce the first HE episode. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
01632116
Volume :
62
Issue :
3
Database :
Complementary Index
Journal :
Digestive Diseases & Sciences
Publication Type :
Academic Journal
Accession number :
121387080
Full Text :
https://doi.org/10.1007/s10620-016-4425-6