The Presence and Severity of NAFLD are Associated With Cognitive Impairment and Hippocampal Damage
The Presence and Severity of NAFLD are Associated With Cognitive Impairment and Hippocampal Damage
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DOI：
10.1210/clinem/dgad352
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发表时间：
2023-06-13
影响因子：
5.8
通讯作者：
Bi, Yan
中科院分区：
文献类型：
--
作者：
Miao, Yingwen;Zhang, Bing;Bi, Yan
背景尽管非酒精性脂肪性肝病（NAFLD）的认知障碍近年来受到关注，但对组织学诊断个体的详细认知功能知之甚少。目的 本研究旨在探讨肝脏病理变化与认知特征的关系，并进一步探讨潜在的脑表现。方法和患者 我们对 320 名接受肝活检的受试者进行了一项横断面研究。在登记的参与者中，225 人接受了整体认知和认知子领域的评估。此外，70 人接受了功能性磁共振成像扫描以进行神经影像评估。使用结构方程模型评估肝脏组织学特征、大脑改变和认知功能之间的关联。结果与对照组相比，NAFLD患者的即时记忆和延迟记忆均较差。严重的肝脏脂肪变性（比值比，2.189；95% CI，1.020-4.699）和气球样变性（OR，3.655；95% CI，1.419-9.414）与较高比例的记忆障碍有关。结构性磁共振成像显示，非酒精性脂肪性肝炎患者的左侧海马体及其下托和前下托亚区域出现体积损失。基于任务的磁共振成像显示，非酒精性脂肪性肝炎患者的左侧海马激活减少。路径分析表明，较高的 NAFLD 活动得分与较低的下托体积和减少的海马激活相关，而这种海马损伤导致较低的延迟记忆得分。结论 我们首次报告 NAFLD 的存在及其严重程度与记忆障碍和海马结构和功能异常的风险增加有关。这些发现强调了 NAFLD 患者早期认知评估的重要性。
Context Although cognitive impairment in nonalcoholic fatty liver disease (NAFLD) has received attention in recent years, little is known about detailed cognitive functions in histologically diagnosed individuals. Objective This study aimed to investigate the association of liver pathological changes with cognitive features and further explore the underlying brain manifestations. Methods and Patients We performed a cross-sectional study in 320 subjects who underwent liver biopsy. Among the enrolled participants, 225 underwent assessments of global cognition and cognitive subdomains. Furthermore, 70 individuals received functional magnetic resonance imaging scans for neuroimaging evaluations. The associations among liver histological features, brain alterations, and cognitive functions were evaluated using structural equation model. Results Compared with controls, patients with NAFLD had poorer immediate memory and delayed memory. Severe liver steatosis (odds ratio, 2.189; 95% CI, 1.020-4.699) and ballooning (OR, 3.655; 95% CI, 1.419-9.414) were related to a higher proportion of memory impairment. Structural magnetic resonance imaging showed that patients with nonalcoholic steatohepatitis exhibited volume loss in left hippocampus and its subregions of subiculum and presubiculum. Task-based magnetic resonance imaging showed that patients with nonalcoholic steatohepatitis had decreased left hippocampal activation. Path analysis demonstrated that higher NAFLD activity scores were associated with lower subiculum volume and reduced hippocampal activation, and such hippocampal damage contributed to lower delayed memory scores. Conclusions We are the first to report the presence and severity of NAFLD to be associated with an increased risk of memory impairment and hippocampal structural and functional abnormalities. These findings stress the significance of early cognitive evaluation in patients with NAFLD.