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Metabolic Brain Disease

, Volume 28, Issue 3, pp 473–483

First Online: 28 April 2013Received: 15 November 2012Accepted: 04 April 2013DOI: 10.1007-s11011-013-9405-3

Cite this article as: Torres, D.S., Abrantes, J. & Brandão‐Mello, C.E. Metab Brain Dis 2013 28: 473. doi:10.1007-s11011-013-9405-3


Minimal hepatic encephalopathy is a syndrome caused by liver cirrhosis and accompanied by a broad spectrum of cognitive symptoms. The objective of the present study was to describe the prevalence of minimal hepatic encephalopathy in cirrhotic patients and to compare their cognitive performance with controls using standardized tests. Patients receiving medication or experiencing comorbidities associated with cognitive disorders were excluded. The final cohort was compared with a control-matched group using the Mini-Mental State Examination MMSE, as well as Simple Drawing, Clock Drawing, Rey Auditory-Verbal Learning Test RAVLT, Random Letter, Stroop, Trail-Making Test TMT A and B, Boston Naming, Category Verbal Fluency, Digit Span, Constructional Praxis, Processing Speed, and Similarities Tests. The results indicated no differences in the prevalence of cognitive complaints spontaneously reported by 29 patients with cirrhosis versus 22 healthy controls. The most affected tests included: MMSE 26.3 ± 2 vs. 28.1 ± 1.8 points; p = 0.004, learning 35.4 ± 9 vs. 41 ± 9.1 points; p = 0.041, retroactive interference 0.67 ± 0.22 vs. 0.84 ± 0.16 points; p = 0.004, and recognition 8.7 ± 2.6 vs. 11.2 ± 4.1 points; p = 0.024 in RAVLT, TMT-A 63.2 ± 29.3 vs. 47.6 ± 16.5 s; p = 0.029 and TMT-B 197.9 ± 88.1 vs. 146.8 ± 76.5 s; p = 0.03. No differences were observed with respect to age, gender, and education. In conclusion, MMSE proved to be a useful tool for detecting global cognitive impairment experienced by cirrhosis patients. Moreover, the most impaired cognitive functions were verbal episodic memory and information processing speed. These findings suggest that minimal hepatic encephalopathy represents a disorder that affects the medial temporal system and, possibly, the prefrontal cortex, and this requires further study.

KeywordsCirrhosis Minimal hepatic encephalopathy Cognitive tests Cognitive impairment  Download fulltext PDF

Author: D. S. Torres - J. Abrantes - C. E. Brandão‐Mello


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