Features of formation of cognitive disorders in hepatic encephalopathy

Abstract

Cognitive impairment is an obligate syndrome in diseases of the hepatobiliary system, which can negatively affect the course of the underlying disease. However, the issues of early diagnosis and treatment of cognitive impairments in these patients remain unresolved. We examined 91 patients with hepatic encephalopathy due to chronic hepatitis (48 patients, of whom 21 are men and 23 women) and liver cirrhosis (47 patients, of which 27 are men and 20 women). The patients’ age was 50.6 ± 9.3 years. All patients underwent a thorough somatic clinical, laboratory and instrumental examination, on the basis of which the diagnoses of chronic hepatitis and liver cirrhosis were confirmed. Further clinical, neurological, psychodiagnostic and instrumental examination, which was carried out on the basis of the “University Clinic” of Kharkiv National Medical University in compliance with the principles of bioethics and medical deontology, made it possible to diagnose hepatic encephalopathy (HE) and determine its stage. The data obtained showed that the early clinical manifestations of HE are cognitive impairments, which are detected during active questioning of patients and with the help of psychometric testing already in the latent stage of HE. At the same time, the most vulnerable areas of cognitive functioning were attention, delayed reproduction of memorized material (dynamic memory impairment), intellectual flexibility, speech speed, which were impaired earlier than other cognitive functions in hepatic encephalopathy. Generalization and comparison of the results of psychometric testing and neuroimaging data indicated the involvement of the dorsolateral cortex in the pathological process in the early stages of HE and the disturbance of the frontal-subcortical connections, and later the defeat of the basal ganglia and temporo-parietal areas of the cortex. The results obtained showed the diagnostic value of the SDMT test for the early detection of cognitive impairments in this patient population.