Background & Aim Falls are frequent in patients with cirrhosis but underlying mechanisms are unknown. The aim was to determine the neuropsychological, neurological and brain alterations using magnetic resonance-diffusion tensor imaging (MR-DTI) in cirrhotic patients with falls. Patients and methods Twelve patients with cirrhosis and falls in the previous year were compared to 9 cirrhotic patients without falls. A comprehensive neuropsychological and neurological evaluation of variables that may predispose to falls included: the Mini-Mental State Examination, Psychometric Hepatic Encephalopathy Score (PHES), Parkinson’s Disease-Cognitive Rating Scale, specific tests to explore various cognitive domains, Unified Parkinson’s Disease Rating Scale to evaluate parkinsonism, scales for ataxia and muscular strength, and electroneurography. High-field MR (3T) including DTI and structural sequences was performed in all patients. Results The main neuropsychological findings were impairment in PHES (p = 0.03), Parkinson’s Disease-Cognitive Rating Scale (p = 0.04) and in executive (p<0.05) and visuospatial-visuoconstructive functions (p<0.05) in patients with falls compared to those without. There were no statistical differences between the two groups in the neurological evaluation or in the visual assessment of MRI. MR-DTI showed alterations in white matter integrity in patients with falls compared to those without falls (p<0.05), with local maxima in the superior longitudinal fasciculus and corticospinal tract. These alterations were independent of PHES as a covariate and correlated with executive dysfunction (p<0.05). Conclusions With the limitation of the small sample size, our results suggest that patients with cirrhosis and falls present alterations in brain white matter tracts related to executive dysfunction. These alterations are independent of PHES impairment.
Alterations in Cerebral White Matter and Neuropsychology in Patients with Cirrhosis and Falls
B. Gómez-Anson,E. Román,R. Fernández de Bobadilla,Patricia Pires-Encuentra,Jordi Díaz-Manera,F. Núñez,S. Martínez-Horta,Y. Vives-Gilabert,J. Pagonabarraga,J. Kulisevsky,J. Córdoba,C. Guarner,G. Soriano
Published 2015 in PLoS ONE
ABSTRACT
PUBLICATION RECORD
- Publication year
2015
- Venue
PLoS ONE
- Publication date
2015-03-20
- Fields of study
Medicine
- Identifiers
- External record
- Source metadata
Semantic Scholar, PubMed
CITATION MAP
EXTRACTION MAP
CLAIMS
CONCEPTS
- corticospinal tract
A major motor white matter pathway extending from the cerebral cortex through the brainstem toward the spinal cord.
Aliases: CST
- diffusion tensor imaging
An MRI method that estimates white matter microstructure from the directional diffusion of water molecules.
Aliases: DTI, MR-DTI
- executive dysfunction
Impairment in higher-order cognitive control processes such as planning, flexibility, and inhibition.
Aliases: executive function impairment
- falls
Occurrences of unintentionally coming to rest on the ground or a lower level, recorded here as having occurred in the previous year.
- parkinson's disease-cognitive rating scale
A cognitive rating instrument originally developed for Parkinson's disease and used here in the neuropsychological evaluation.
- psychometric hepatic encephalopathy score
A composite neuropsychological score used to screen cognitive impairment associated with hepatic encephalopathy.
Aliases: PHES
- superior longitudinal fasciculus
A major association white matter tract linking frontal, parietal, temporal, and occipital regions.
Aliases: SLF
- white matter integrity
The microstructural organization of brain white matter as assessed from diffusion tensor imaging metrics.
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