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Cognitive reserve is a resilience factor for cognitive dysfunction in hepatic encephalopathy

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Abstract

Cognitive Reserve (CR) modulates symptoms of brain disease. The aim of this study was: to evaluate the effect of CR on cognition in cirrhosis and on the mismatch between cognitive and neurophysiologic assessment of hepatic encephalopathy (HE). Eighty-two outpatient patients with cirrhosis without overt HE were studied [73% males; age: 62 (54–68) (median, interq. range) yrs.; education: 8 (6–13) yrs.]. The Psychometric Hepatic Encephalopathy Score (PHES) was used as cognitive measure of HE. The spectral analysis of the electroencephalogram (EEG) was used as neurophysiologic measure of HE. The CR was assessed by the CR Index (CRI), which was measured by the CRI questionnaire (CRIq) (http://cri.psy.unipd.it). The PHES was altered in 28% of patients and the EEG in 41%. Altered PHES was related to the severity of cirrhosis as assessed by Child-Pugh classification (R = 0.31, p < 0.005). Patients with maintained PHES had higher CRI than those with altered PHES (CRI = 100 ± 20 vs. 88 ± 12 vs., p < 0.01), but not the ones with normal EEG compared to those with abnormal EEG (CRI = 96 ± 17 vs. 98 ± 17 vs. p: n.s.).The PHES, but not the EEG, was found to be related to the CRI (r = 0.35, p < 0.01). The mismatch between cognitive and neurophysiologic evaluation of non-overt HE (the ratio between PHES and the mean dominant frequency -MDF- of the EEG i.e., cognitive performance normalized by EEG speed) was found to be correlated to the CRI (r = 0.36, p < 0.005). CR is a resilience factor for cognitive dysfunction in cirrhosis, and is easily measurable by CRIq.

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Abbreviations

EEG:

electroencephalogram

CR:

cognitive reserve

CRI:

cognitive reserve index

CRIq:

cognitive reserve index questionnaire

MHE:

minimal hepatic encephalopathy

MDF:

mean dominat frequency of the EEG

PHES:

psychometric hepatic encephalopathy score

HE:

hepatic encephalopathy

IQ:

intelligence quotient

DST:

Digit Symbol test

TMT-A:

Trail Making Tests A

TMT-B:

Trail Making Tests B

SDT:

Serial Dotting Test

LTT:

line trait test

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Authors and Affiliations

  1. Department of Medicine-DIMED- & CIRMANMEC, University of Padua, Padova, Italy

    Piero Amodio, Sara Montagnese & Sami Schiff

  2. Clinica Medica 5, via Giustinini 2, 35128, Padova, Italy

    Piero Amodio, Sara Montagnese & Sami Schiff

  3. Department of Psychology, Sapienza University of Rome, Rome, Italy

    Giuseppe Spinelli

  4. Department of General Psychology & CIRMANMEC, University of Padua, Padova, Italy

    Daniela Mapelli

Authors
  1. Piero Amodio
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  2. Sara Montagnese
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  3. Giuseppe Spinelli
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  4. Sami Schiff
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  5. Daniela Mapelli
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Correspondence to Piero Amodio.

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Funding

Funding for this research was provided by the University of Padua to P.A., S.M. and D.M. and by the Forin-Hepatos Fundation, Padua, Italy.

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Amodio, P., Montagnese, S., Spinelli, G. et al. Cognitive reserve is a resilience factor for cognitive dysfunction in hepatic encephalopathy. Metab Brain Dis 32, 1287–1293 (2017). https://doi.org/10.1007/s11011-017-0032-2

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  • DOI: https://doi.org/10.1007/s11011-017-0032-2

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