HEPATIC ENCEPHALOPATHY--NEUROPSYCHOLOGY & NEUROCHEMISTRY

描述：(逐字摘自申请者摘要)肝性脑病 是公认的肝硬变并发症。这些患者表现出 各种神经心理缺陷以及临床和血氨 异常现象。亚临床肝性脑病(SHE)是一种微妙的疾病 与神经心理相关的肝硬变伴发 没有明显神经学发现的异常，如星状突起。 虽然神经心理测试是目前诊断SHE的标准， 这些结果是非特定的，几乎没有揭示出潜在的 神经化学过程。脑磁共振波谱(MRS) 基底节的代谢改变和MRI信号异常显示 神经心理功能与生化指标的关系 SHE患者中发现的异常。这项研究将涉及协作 在血液学家、放射学家、精神病学家、MR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名健康对照组进行比较。这些病人和 健康对照将接受肝病专家和 精神病学家的神经精神病学评估。随后，他们将经历一次 一系列全面的神经心理测试以表征精神分裂症的性质 他们的神经认知缺陷。在这些测试之后，所有的受试者都将接受 磁共振成像和波谱(MRI/MRS)检查。我们的目标是使用1H MRS TO 测量并比较脑部代谢产物肌醇、胆碱、 和谷氨酰胺/谷氨酸在额叶、顶叶和基底节的分布 一组匹配的SHE患者和健康对照组。由此产生的MRS和MRI 将对数据进行量化分析并将其与以下结果相关联 神经心理测试和临床检查。多变量方法和 相关分析将被用来检验关于差异的假设 在SHE患者和对照组之间。我们假设肌醇将会是 降低，谷氨酰胺/谷氨酸升高，胆碱降低 与她同病相怜。我们认为这些潜在的生物化学 异常与临床、神经精神病学和 SHE的神经心理学方面。如果找到了这些关系，他们将 提供对SHE下划线方面的更好的生化理解 以临床和神经心理测试为特征。这增强了 了解病理生理学将提高我们的诊断和治疗能力 这一状况，导致改善了患者的预后。

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.