Minimal Hepatic Encephalopathy and Mild Cognitive Impairment Worsen Quality of Life in Elderly Patients With Cirrhosis.
Minimal Hepatic Encephalopathy and Mild Cognitive Impairment Worsen Quality of Life in Elderly Patients With Cirrhosis.
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DOI：
10.1016/j.cgh.2020.03.033
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发表时间：
2020-12
期刊：
影响因子：
--
通讯作者：
Vargas HE
中科院分区：
文献类型：
--
作者：
Bajaj JS;Duarte-Rojo A;Xie JJ;Acharya C;Wade JB;Robles C;Thacker LR;Flud C;Fagan A;Garcia-Saenz-de-Sicilia M;White MB;Kelly M;Nguyen V;Gavis EA;Vargas HE
肝硬化患者的年龄越来越大。轻度肝性脑病（MHE）和痴呆前轻度认知功能障碍（MCI）的重叠可能影响生活质量（QOL）。我们调查了老年肝硬化患者在MHE和MCI测试中的表现及其对生活质量的影响。我们在4个中心招募了65岁或以上的肝硬化（n= 109）和非肝硬化（对照组，n=100）门诊患者（衍生队列）。所有研究参与者都接受了心理测量肝性脑病评分（PHES）、EncephalApp评分和QOL评估。MCI在肝硬化患者中进行了测试，使用可重复的电池评估神经心理状态，并分配到以下组：未受损，MCI，MHE，MCI+MHE。我们使用PHES和对照组的EncephalApp评分创建了调整后的标准来检测MHE。使用来自同一研究中心的77例肝硬化患者（平均年龄，69.49± 4.36岁; 72%为男性）的单独队列的数据验证了结果。对照组年龄较大，但受教育程度较高，认知能力较好，生活质量较好。在肝硬化患者中，年龄、教育程度、终末期肝病模型评分、EncephalApp评分和QOL相似，但不同研究中心的PHES和用于评估神经心理状态的可重复组合评分不同。在衍生队列中，MHE的存在，伴或不伴MCI，与不良QOL相关，在MCI+MHE组中最低。当我们调整年龄，性别和教育时，49%的肝硬化患者根据EncephalApp患有MHE，8%的患者根据PHES患有MHE。在确认队列中发现了相似的模式（基于EncephalApp的MHE为49%，基于PHES的MHE为6%）。在一项对肝硬化患者（65岁以上）和对照组的多中心研究中，MHE的存在与认知和生活质量差相关，与MCI无关。我们创建了调整后的标准，定义了EncephalApp在老年人中检测MHE的高灵敏度，并在单独的队列中进行了验证。
Patients with cirrhosis are growing older. The overlap between minimal hepatic encephalopathy (MHE) and pre-dementia mild cognitive impairment (MCI) could affect quality of life (QOL). We investigated the performance of elderly patients with cirrhosis on tests for MHE and MCI and their effects on QOL. We recruited outpatients with cirrhosis (n=109) and without cirrhosis (controls, n=100), 65 y or older, at 4 centers (derivation cohort). All study participants were assessed for psychometric hepatic encephalopathy score (PHES), EncephalApp score, and QOL. MCI was tested in patients with cirrhosis using the repeatable battery for assessment of neuropsychological status and assigned to the following groups: unimpaired, MCI-only, MHE-only, and MCI+MHE. We created adjusted norms to detect MHE using PHES and EncephalApp scores from the controls. Findings were validated using data from a separate cohort of 77 patients with cirrhosis (mean age, 69.49±4.36y; 72% men) at the same study sites. Controls were older but were more educated, performed better cognitively, and had better QOL. Among patients with cirrhosis, age, education, model for end-stage liver disease score, EncephalApp score, and QOL were similar but PHES and repeatable battery for assessment of neuropsychological status differed among sites. In the derivation cohort, presence of MHE, with or without MCI, associated with poor QOL, which was lowest in the MCI+MHE group. When we adjusted for age, sex, and education, 49% of patients with cirrhosis had MHE based on the EncephalApp and 8% had MHE based on the PHES. A similar pattern (49% MHE based on EncephalApp and 6% MHE based on PHES) was found in a validation cohort. In a multi-center study of patients with cirrhosis (older than 65 y) and controls, the presence of MHE, regardless of MCI, associated with poor cognition and QOL. We created adjusted norms that defined the high sensitivity of EncephalApp for detection of MHE in older individuals and validated it in a separate cohort.
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DOI：
10.1016/j.jceh.2013.12.005
发表时间：
2014-06-01
影响因子：
3
作者：
Corrias, Michela;Turco, Matteo;Montagnese, Sara
通讯作者：
Montagnese, Sara
影响因子：
4.6
作者：
Bajaj JS;Ahluwalia V;Steinberg JL;Hobgood S;Boling PA;Godschalk M;Habib S;White MB;Fagan A;Gavis EA;Ganapathy D;Hylemon PB;Stewart KE;Keradman R;Liu EJ;Wang J;Gillevet PM;Sikaroodi M;Moeller FG;Wade JB
通讯作者：
Wade JB
影响因子：
3
作者：
BERGNER, M;BOBBITT, RA;GILSON, BS
通讯作者：
GILSON, BS
影响因子：
25.7
作者：
Koehler, Edith M.;Schouten, Jeoffrey N. L.;Janssen, Harry L. A.
通讯作者：
Janssen, Harry L. A.
影响因子：
25.7
作者：
Asrani, Sumeet K.;Devarbhavi, Harshad;Kamath, Patrick S.
通讯作者：
Kamath, Patrick S.