HEPATIC ENCEPHALOPATHY--NEUROPSYCHOLOGY & NEUROCHEMISTRY

描述：（逐字摘自申请人摘要）肝性脑病 (HE)是公认的肝硬化并发症这些患者表现出 各种神经心理缺陷以及临床和血清氨 异常亚临床肝性脑病（SHE）是一种 伴有神经心理学相关的肝硬化 无显著神经学发现的异常，如脑出血。 虽然神经心理学测试是目前诊断SHE的标准， 结果是非特异性的，几乎没有揭示潜在的 神经化学过程脑磁共振波谱（MRS） 基底神经节的代谢改变和MRI信号异常揭示了 神经心理功能和生物化学之间的关系 在SHE患者中发现的异常。这项研究将涉及合作 在血液科医生、放射科医生、精神科医生、磁共振物理学家和 神经心理学家我们将确定总共60名肝功能衰竭患者， 并将其与60名健康对照受试者进行比较。这些患者和 健康对照将接受肝病学家的临床评估， 精神科医生的神经精神评估。随后，他们将接受 一系列神经心理学测试，以表征 神经认知缺陷在这些测试之后，所有受试者将接受 磁共振成像和波谱（MRI/MRS）检查。我们的目标是使用1H MRS， 测量并比较肌醇，胆碱， 和谷氨酰胺/谷氨酸在额叶，顶叶和基底神经节的 一组匹配的SHE患者和健康对照组。由此产生的MRS和MRI 将对数据进行定量分析，并与 神经心理学测试和临床检查。多变量方法和 相关分析将用于检验关于差异的假设 SHE患者和对照组之间的差异。我们假设肌醇会 降低，谷氨酰胺/谷氨酸盐将增加，胆碱将减少 在病人与她。我们认为这些潜在的生物化学 异常将与临床、神经精神和 神经心理学方面。如果这些关系被发现， 提供对SHE的强调方面的更好的生物化学理解 临床和神经心理学测试的特征。这种增强 对病理生理学的理解将提高我们诊断和治疗的能力， 这种情况，导致改善患者的结果。

DESCRIPTION: (Verbatim from the Applicant's Abstract) Hepatic Encephalopathy (HE) is a well-recognized complication of cirrhosis. These patients display a variety of neuropsychological deficits as well as clinical and serum ammonia abnormalities. Sub-clinical hepatic Encephalopathy (SHE) is a subtler accompaniment of cirrhosis that is associated with neuropsychological abnormalities without significant neurologic findings such as asterixis. Although neuropsychological tests are the current standard for diagnosing SHE, the results are non-specific and reveal little about the underlying neurochemical processes. Cerebral Magnetic Resonance Spectroscopic (MRS) metabolic alterations and MRI signal abnormalities in the basal ganglia reveal a relationship between neuropsychological functioning and biochemical abnormalities found in patients with SHE. This study will involve collaboration among hematologists, radiologists, psychiatrists, MR physicists and neuropsychologists. We will identify a total of 60 liver failure patietns who have SHE and compare them to 60 healthy control subjects. These patients and healthy controls will undergo clinical assessment by hepatologists and neuropsychiatric evaluation by psychiatrists. Subsequently, they will undergo a comprehensive series of neuropsychological tests to characterize the nature of their neurocognitive deficits. Following these tests, all subjects will undergo MR Imaging and Spectroscopic (MRI/MRS) examinations. We aim to use 1H MRS to meare and compare absolute cerebral metabolite levels of myo-inositol, choline, and glutamine/glutamate in the frontal lobe, parietal lobe and basal ganglia of a matched group of SHE patients and healthy controls. The resulting MRS and MRI data will be quantitatively analyzed and correlated with the results of neuropsychological testing and clinical examination. Multivariate methods and correlational analysis will be used to test hypotheses regarding differences between SHE patients and controls. We hypothesize that myo-inositol will be decreased, glutamine/glutamate will be increased and choline will be decreased in patietns with SHE. We propose that these underlying biochemical abnormalities will be correlated with clinical, neuropsychiatric and neuropsychological aspects of SHE. If these relationships are found, they will provide an improved biochemical understanding of the underlined aspects of SHE as characterized y clinical and neuropsychological testing. This enhanced understanding of pathophysiology will improve our ability to diagnose and treat this condition, resulting in improved patient outcomes.