Evaluation of cognitive dysfunction in patients with liver cirrhosis

Introduction: The commonest complication of liver cirrhosis is hepatic encephalopathy. Hepatic encephalopathy is a complication of acute or chronic liver disease. Clinically hepatic encephalopathy can be classified as overt and Minimal. Minimal hepatic encephalopathy represents cognitive deficits in the absence of Overt encephalopathy. Aims and Objectives: The study is conducted to evaluate cognitive dysfunction ,which is a marker of subclinical or Minimal hepatic encephalopathy in liver cirrhotics by Minimental state examination and Number connection test. Materials and Methods: 30 liver cirrhotics of both sexes in the age group 30 and 58 of various etiology with atleast primary school education and without clinical evidence of hepatic encephalopathy were included in the study. controls were age and sex matched healthy population. Both the controls and cirrhotics are subjected to MMSE, number connection test. Mean > 2 SD of controls was considered as cut off point for the diagnosis of minimal hepatic encephalopathy .The data were analysed by students ‘t’ test. Results: MMSE scoring showed no significant difference between both the groups. Controls were able to perform better in number connection test than cirrhotics (41.27 ± 11 vs 105 ± 49). About 63 % of cirrhotics had abnormal number connection test suggestive of cognitive impairement .No significant difference was observed in number connection test between alcoholic and nonalcoholic cirrhotics. Thus alcohol as independent factor in cognitive dysfunction can be ruled out. Conclusion: Though all patients had preserved language, memory and verbal abilities there is significant cognitive impairement such as impaired attention and visuospatial orientation which may indicate minimal hepatic encephalopathy. This suggest the possibility that this disorder mainly affects prefrontal cortex and circuit between basal ganglia and prefrontal cortex. Thus periodic evaluation with number connection test may be helpful in diagnosing subclinical hepatic encephalopathy.