Focal cortical damage parallels cognitive impairment in minimal hepatic encephalopathy

Little attention has been paid to cortical integrity in patients with minimal hepatic encephalopathy (MHE), although cognitive functions affected in early stages of liver disease are mainly allocated in different neocortical structures. Here we used cortical surface-based analysis techniques to inve...

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Bibliographic Details
Published in:NeuroImage (Orlando, Fla.) Fla.), 2012-07, Vol.61 (4), p.1165-1175
Main Authors: Montoliu, Carmina, Gonzalez-Escamilla, Gabriel, Atienza, Mercedes, Urios, Amparo, Gonzalez, Olga, Wassel, Abdallah, Aliaga, Roberto, Giner-Duran, Remedios, Serra, Miguel A., Rodrigo, Jose M., Belloch, Vicente, Felipo, Vicente, Cantero, Jose L.
Format: Article
Language:English
Subjects:
Ammonia
Cerebral Cortex - pathology
Cognition Disorders - etiology
Cognition Disorders - pathology
Cognitive ability
Cognitive impairment
Cortical thickness
Early Diagnosis
Female
Hepatic cirrhosis
Hepatic Encephalopathy - complications
Hepatic Encephalopathy - pathology
Humans
Image Interpretation, Computer-Assisted
Liver cirrhosis
Liver diseases
Magnetic Resonance Imaging
Male
Middle Aged
Minimal hepatic encephalopathy
Mortality
Neuropsychological Tests
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Summary:Little attention has been paid to cortical integrity in patients with minimal hepatic encephalopathy (MHE), although cognitive functions affected in early stages of liver disease are mainly allocated in different neocortical structures. Here we used cortical surface-based analysis techniques to investigate if patterns of cortical thinning accompany the mildest form of HE. To aim this goal, cortical thickness obtained from high-resolution 3T magnetic resonance imaging (MRI) was measured in patients with no MHE (NMHE), MHE, and healthy controls. Further correlation analyses were performed to examine whether scores in the critical flicker frequency (CFF) test, and blood ammonia levels accounted for the loss of cortical integrity in different stages of liver disease. Finally, we assessed group differences in volume of different subcortical regions and their potential relationships with CFF scores/blood ammonia levels. Results showed a focal thinning of the superior temporal cortex and precuneus in MHE patients when compared with NMHE and controls. Relationships between blood ammonia levels and cortical thickness of the calcarine sulcus accounted for impaired visual judgment in patients with MHE when compared to NMHE. Regression analyses between cortical thickness and CFF predicted differences between controls and the two groups of HE patients, but failed to discriminate between patients with NMHE and MHE. Taking together, these findings provide the first report of cortical thinning in MHE patients, and they yield novel insights into the neurobiological basis of cognitive impairment associated with early stages of liver diseases.
ISSN:1053-8119
1095-9572
DOI:10.1016/j.neuroimage.2012.03.041