Minimal hepatic encephalopathy in patients with liver cirrhosis: magnetic resonance spectroscopic brain findings versus neuropsychological changes.

BACKGROUND AND STUDY AIM: Minimal hepatic encephalopathy (MHE) is a subtle complication of cirrhosis that may have a detrimental effect on daily functioning and may progress to overt hepatic encephalopathy (HE). The aims of this study were to identify MHE and assess neuropsychological changes in those patients.

PATIENTS AND METHODS: A case-control study was conducted in 35 cirrhotic patients. MHE was identified by brain (hydrogen-1) magnetic resonance spectroscopy ((1)H-MRS). Neuropsychological changes were evaluated using cognitive abilities screening instrument (CASI) test, Hamilton depression scale, and soft neurological sign assessment.

RESULTS: Of the patients, 16 (45.7%) had significant brain (1)H-MRS findings suggesting MHE in the form of decreased myo-Inositol/creatine (mI/Cr) and choline/creatine (Cho/Cr) ratios and increased glutamine-glutamate/creatine (Glx/Cr) ratios in white and grey matters compared to patients without MHE and healthy controls. Patients with MHE had significantly lower abstract thinking subset and total CASI score in comparison to patients without MHE (p=0.03 and p=0.05, respectively) and controls (p=0.003 and p=0.02, respectively). No statistically significant differences were observed amongst different groups regarding other CASI subsets, depression, and soft neurological assessment in spite of a tendency towards increased values in patients with MHE.

CONCLUSION: MHE associated with neurophysiological changes demonstrated by (1)H-MRS preceded neuropsychological changes. Thus, (1)H-MRS may be considered as a potential tool for diagnosis of cirrhosis-associated cerebral dysfunction and a promising method for prioritisation of subjects awaiting liver transplantation.