Persistence of cognitive impairment after resolution of overt hepatic encephalopathy.
Persistence of cognitive impairment after resolution of overt hepatic encephalopathy.
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DOI：
10.1053/j.gastro.2010.02.015
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发表时间：
2010-06
期刊：
影响因子：
29.4
通讯作者：
Sanyal AJ
中科院分区：
文献类型：
--
作者：
Bajaj JS;Schubert CM;Heuman DM;Wade JB;Gibson DP;Topaz A;Saeian K;Hafeezullah M;Bell DE;Sterling RK;Stravitz RT;Luketic V;White MB;Sanyal AJ
在肝硬化患者中，肝性脑病（HE）有急性但可逆的以及慢性成分。我们调查了显性HE（OHE）临床消退后残留认知功能障碍的程度。采用数字符号测验（DS）、区组设计（BD）、数字连接测验（NCT-A &B）和抑制控制测验（ICT）评价认知功能。ICT诱饵的改善（减少）和第一减第二半（ΔL1-2）用于确定反应抑制的学习。两项横断面研究（A和B）比较了既往有或无OHE的稳定性前列腺癌患者的数据。然后，我们前瞻性地评估了第一次OHE发作前后的认知表现。在研究A中，（226名癫痫患者）54名经历了OHE，120名有轻微HE，52名没有轻微HE。尽管OHE后乳果糖的精神状态正常，但根据所有测试的结果，自闭症患者的认知功能受损。反应抑制的学习（ΔL1-2 ≥1）在极轻微HE和无极轻微HE的患者中明显，但在OHE后丢失。在研究B中（另外50例患者在随访期间发生≥1次记录的OHE发作），OHE住院次数与残留损害的严重程度相关，由ICT诱饵（r=0.5，P=0.0001）、DST（r=-0.39，P=0.002）和NCT-B（r=0.33，P=0.04）表示。在前瞻性研究中（59例无OHE的患者），15例发生OHE; OHE后ICT诱饵反应显著恶化（12例前vs.18例后，P=0.0003），反应抑制的学习丧失。44名未经历OHE的患者在系列测试中没有认知功能恶化。在肝硬化中，OHE的发作与工作记忆、反应抑制和学习的持续和累积缺陷相关。
In patients with cirrhosis, hepatic encephalopathy (HE) has acute but reversible as well as chronic components. We investigated the extent of residual cognitive impairment following clinical resolution of overt HE (OHE). Cognitive function of cirrhotic patients was evaluated using psychometric tests (digit symbol [DS], block design [BD], and number connection [NCT-A&B]) and the inhibitory control test (ICT). Improvement (reduction) in ICT lures and 1st minus 2nd halves (ΔL1–2) were used to determine learning of response inhibition. Two cross-sectional studies (A and B) compared data from stable cirrhotics, with or without prior OHE. We then prospectively assessed cognitive performance, before and after the first episode of OHE. In study A, (226 cirrhotic patients) 54 had experienced OHE, 120 had minimal HE and 52 with no minimal HE. Despite normal mental status on lactulose after OHE, cirrhotics were cognitively impaired, based on results from all tests. Learning of response inhibition (ΔL1–2 ≥1), was evident in patients with minimal HE and no minimal HE, but was lost after OHE. In study B (50 additional patients who developed ≥1 documented OHE episode during follow-up), the number of OHE hospitalizations correlated with severity of residual impairment, indicated by ICT lures (r=0.5, P=0.0001), DST (r=−0.39, P=0.002) and NCT-B (r=0.33, P=0.04). In the prospective study (59 cirrhotics without OHE), 15 developed OHE; ICT lure response worsened significantly after OHE (12 before vs.18 after, P=0.0003) and learning of response inhibition was lost. The 44 patients who did not experience OHE did not have deteriorations in cognitive function in serial testing. In cirrhosis, episodes of OHE are associated with persistent and cumulative deficits in working memory, response inhibition, and learning.
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DOI：
10.1073/pnas.96.14.8301
发表时间：
1999-07-06
影响因子：
11.1
作者：
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通讯作者：
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影响因子：
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FAN, P;LAVOIE, J;BUTTERWORTH, RF
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BUTTERWORTH, RF
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影响因子：
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BERGERON, M;READER, TA;BUTTERWORTH, RF
通讯作者：
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