Cognitive impairment in recipients of liver transplantation and relation to hepatic encephalopathy

Abstract Background Liver transplantation (LT) helped to save the life of end stage liver disease (ESLD) patients; however, there is a debate on the persistence of cognitive impairment. The study aimed to evaluate cognitive functions in patients with ESLD before and after liver transplantation and to assess its relation to hepatic encephalopathy (HE). Thirty recipients 47.6 ± 11 years undergone living donor liver transplantation at the transplantation center of both Ain Shams Center for Organ Transplant and Egypt air organ transplant unit were prospectively assessed by Trail Making Test, Wechsler Memory Scale–Revised, Benton Visual Retention—for the evaluation of cognitive functions before and 3 months after transplantation. Results The mean age of the patients was 47.6 ± 11 years, 17 males and 13 females. Eight out of 30 (26.7%) had past history of hepatic encephalopathy. The study reported significant improvement in the post-operative 3 months scores of Trail Making Test part (A), the digit span forward test, digit span backward test and the correct score difference of the Benton Visual Retention, as p value was (0.02), (0.01) (0.02), and (0.01) respectively, compared to the pre-operative scores. However, there was no difference in the scores of part (B), verbal association I, II, information subtest of WMS. Cognitive performance showed no significant difference between patients with or without history of HE. Conclusions Patients with ESLD have significant cognitive impairment that showed improvement after LT; HE did not correlate with cognitive function. Hence, transplantation has a favorable outcome on the cognitive impairment.

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Cardiovascular risk moderates the effect of aerobic exercise on executive functions in older adults with subcortical ischemic vascular cognitive impairment

Scientific Reports ◽

10.1038/s41598-021-99249-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Cindy K. Barha ◽

Elizabeth Dao ◽

Lauren Marcotte ◽

Ging-Yuek Robin Hsiung ◽

Roger Tam ◽

...

Keyword(s):

Cognitive Impairment ◽

Cardiovascular Risk ◽

Executive Functions ◽

Aerobic Exercise ◽

Digit Span ◽

Vascular Cognitive Impairment ◽

Analysis Of Covariance ◽

Trail Making Test ◽

Executive Processes ◽

Trail Making

AbstractAerobic training (AT) can promote cognitive function in adults with Subcortical Ischemic Vascular Cognitive Impairment (SIVCI) by modifying cardiovascular risk factors. However, pre-existing cardiovascular health may attenuate the benefits of AT on cognitive outcomes in SIVCI. We examined whether baseline cardiovascular risk moderates the effect of a 6-month progressive AT program on executive functions with a secondary analysis of a randomized controlled trial in 71 adults, who were randomized to either: (1) 3×/week progressive AT; or (2) education program (CON). Three executive processes were measured: (1) response inhibition by Stroop Test; (2) working memory by digits backward test; and (3) set shifting by the Trail Making Test. Baseline cardiovascular risk was calculated using the Framingham cardiovascular disease (CVD) Risk Score (FCRS), and participants were classified as either low risk (< 20% FCRS score; LCVR) or high risk (≥ 20% FCRS score; HCVR). A complete case analysis (n = 58) was conducted using an analysis of covariance (ANCOVA) to evaluate between-group differences in the three executive processes. A significant interaction was found between cardiovascular risk group and intervention group (AT or CON) for the digit span backward and the Trail Making Test. AT improved performance compared with CON in those with LCVR, while in those with HCVR, AT did not improve performance compared with CON. Baseline cardiovascular risk significantly moderates the efficacy of AT on cognition. Our findings highlight the importance of intervening early in the disease course of SIVCI, when cardiovascular risk may be lower, to reap maximum benefits of aerobic exercise.

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Neuropsychology and MRI Observational Study In An Adult Sickle Cell Disease Population In South East London

Blood ◽

10.1182/blood.v116.21.2642.2642 ◽

2010 ◽

Vol 116 (21) ◽

pp. 2642-2642

Author(s):

Heather Rawle ◽

Paul Holmes ◽

Veronica J Thomas ◽

Ronwyn Cartwright ◽

Jo Howard

Keyword(s):

Health Care ◽

Cognitive Impairment ◽

Executive Functioning ◽

Sickle Cell ◽

Processing Speed ◽

Cognitive Impairments ◽

Trail Making Test ◽

Cerebral Infarcts ◽

History Of ◽

Trail Making

Abstract Abstract 2642 We studied 36 patients attending the sickle cell clinic in our large adult population of over 600 patients. These patients presented to the sickle psychology service because they had a past history of a stroke, or presented with concerns about memory. An MRI brain scan and neuropsychological testing (including tests for IQ, processing speed, executive function and memory) were performed on each patient. The data were organised into four groups in terms of severity of MRI abnormalities: normal MRI n=13; silent cerebral infarcts (subcortical punctate small vessel cerebrovascular disease) n= 11; severe infarcts as an adult n=8; and severe infarcts as a child n=4. The majority of patients with a history of stroke had evidence of large vessel infarcts as well as features of deep watershed ischaemia seen in large vessel (distal internal carotid artery) disease. These groups did not differ significantly in terms of gender, phenotype, age and mood. Cognitive impairments were more prevalent in the severe infarct groups but were also found in patients with silent cerebral infarcts and normal MRIs. Executive functioning and processing speed deficits were evident in all groups but were more severe in the silent cerebral infarct and severe infarct groups. Chi-squared tests for trend showed that the following test scores tended to reduce as MRI abnormalities increased: Full-Scale IQ (p=0.016), Processing Speed Index (p=0.015), Trail Making Test A (p=0.014), Trail Making Test B (p=0.018), and FAS Verbal Fluency Test (p=0.006). This suggests that executive functioning, processing speed and full-scale IQ are particularly vulnerable to the effects of MRI abnormalities in this patient population. Although the cognitive impairments were more severe in the groups with abnormal MRIs, there was significant cognitive impairment in some patients with normal MRIs, suggesting that other factors are also causative of cognitive impairments. These factors may include physiological causes such as impaired perfusion, and psychosocial factors such as disruption to education. These results agree with a recent US study (Vichinsky et al, 2010, JAMA, 303, 1823–1831) showing cognitive impairment in patients with normal MRI scans which implies that MRI is not an adequate screening tool to identify patients with cognitive impairment. This study has important clinical implications in terms of how cognitive deficits can affect the effectiveness of patient – health care professional consultations, patients' ability to manage their SCD and adhere to medication and health care advice. It is important therefore to identify patients with SCD who have such cognitive impairments so appropriate support can be offered. Disclosures: No relevant conflicts of interest to declare.

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Structural and functional changes related to memory deficit in non-demential elderly individuals

Medicina (Ribeirao Preto Online) ◽

10.11606/issn.2176-7262.v49i6p533-548 ◽

2016 ◽

Vol 49 (6) ◽

pp. 533

Author(s):

Nísea De A. Corrêa ◽

Maria P. Foss ◽

Paula R. B. Diniz

Keyword(s):

Systematic Review ◽

Web Of Science ◽

Digit Span ◽

Meta Analysis ◽

Memory Deficit ◽

Trail Making Test ◽

Elderly Individuals ◽

Functional Changes ◽

Wechsler Memory Scale ◽

Trail Making

Objetivo: Verificar as alterações estruturais e funcionais, evidenciadas através da imagem por ressonância magnética, relacionadas aos déficits de memória identificados em idosos normais, quando comparados a adultos jovens. Metodologia: Procedeu-se à revisão sistemática, cujo protocolo obedeceu ao fluxograma do Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Foram investigadas as bases de dados PubMed, Scopus, EBSCO, utilizando o gerenciador de referências JabRef, na versão 2.10, e o Web of Science, pelo website. Foram incluídos artigos de estudos quase experimentais, transversais, em coorte ou tipo caso-controle, publicados entre 2005 e 2014, em periódicos indexados nacionais e internacionais, cuja amostra incluísse idosos a partir de 60 anos, não dementes, submetidos à investigação de alterações estruturais e funcionais do sistema nervoso central, por ressonância magnética e sua associação com déficits de memória avaliados por testes neuropsicológicos. Resultados: Quanto à técnica de imagem empregada, identificaram-se dois estudos com imagem por ressonância magnética estrutural, seis estudos com utilização de imagem por ressonância magnética funcional, e quatro estudos que empregaram ambas as técnicas. Nos 12 estudos foi identificado o emprego de 38 testes neuropsicológicos distintos, com uma média de cinco testes por estudo, com variação de um a 12 testes. Dentre os testes mais usados, estiveram o WAIS Digit Span Backwards (em sete estudos), o Trail Making Test A and B (em quatro estudos) e o Wechsler Memory Scale (em quatro estudos). Conclusão: Os estudos demonstraram que no envelhecimento normal, ocorre redução do volume de substância branca para-hipocampal, do volume do hipocampo e do córtex entorrinal com redução de memória verbal, possivelmente por desmielinização das fibras; redução das vias que ligam o lobo temporal e frontal, contribuindo para a redução da memória episódica, da memória de trabalho e da fluência verbal; redução da supressão de informações irrelevantes, o que contribui para menor registro de informação; alterações das áreas frontal e parietal que comprometem a memória de reconhecimento; modificações na atividade e na conectividade do default mode network; reorganização das funções cognitivas, bem como alentecimento de resposta por provável redução de ativação do córtex pré- frontal

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Diagnostic Efficiency of the Trail Making Test as a Function of Cut-off Score, Diagnosis, and Age

Perceptual and Motor Skills ◽

10.2466/pms.1978.47.1.191 ◽

1978 ◽

Vol 47 (1) ◽

pp. 191-195 ◽

Cited By ~ 11

Author(s):

Norman G. Gordon

Keyword(s):

Analysis Of Covariance ◽

Veterans Administration ◽

Trail Making Test ◽

Diagnostic Efficiency ◽

Male Veterans ◽

Significant Difference ◽

Trail Making ◽

Administration Hospital ◽

Cutoff Scores ◽

The Brain

This study is a reinvestigation of the effectiveness of the Trail Making Test in discriminating between brain-damaged ( n = 51) and pseudoneurologic ( n = 72) subjects. All subjects were hospitalized male veterans at the Allen Park Veterans Administration Hospital. An analysis of covariance showed that the pseudoneurologic subjects performed at a significantly higher level than the brain-damaged subjects. Further analysis with two different cutoff scores exhibited unequal discriminatory power throughout the whole range of Trail Making Test scores. These results suggested diagnosing only when the scores were 9 or lower and 13 or higher. This use of extreme scores resulted in an over-all hit rate of 87% in the study. Comparisons with five major subgroupings of the pseudoneurologic subjects yielded only one significant difference: more accurate discrimination with the 12 cut-off score between 10 general-medical and peripheral nerve-damaged subjects (100% correct) and 18 psychotic subjects (39% accuracy).

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Alteração na atenção e o tratamento da dor do câncer

Revista da Escola de Enfermagem da USP ◽

10.1590/s0080-62342008000100019 ◽

2008 ◽

Vol 42 (1) ◽

pp. 143-151 ◽

Cited By ~ 2

Author(s):

Geana Paula Kurita ◽

Cibele Andrucioli de Mattos Pimenta ◽

José Oswaldo de Oliveira Júnior ◽

Ricardo Caponeiro

Keyword(s):

Digit Span ◽

Trail Making Test ◽

Digit Span Test ◽

Span Test ◽

Trail Making

Os danos à vida diária que a alteração cognitiva pode provocar motivaram a elaboração deste estudo, cujo objetivo foi analisar o impacto do tratamento da dor com opióides sobre a atenção. Os doentes foram divididos em grupos que recebiam (n=14) e não recebiam opióides (n=12). Foram feitas três entrevistas, utilizando-se o Trail Making Test e o Digit Span Test, que avaliam a atenção. Os grupos foram homogêneos nas variáveis sociodemográficas, dor e depressão; não foram homogêneos no índice de Karnofsky e no recebimento de analgésicos adjuvantes. Os doentes sem opióides tiveram melhor desempenho no Digit Span Test - ordem inversa, na segunda avaliação (p=0,29) e não foram observadas diferenças no Trail Making Test. As alterações observadas foram limitadas, mas, enquanto novos estudos não confirmem os achados, doentes, profissionais e cuidadores devem ser alertados dos possíveis efeitos deletérios dos opióides sobre a função cognitiva.

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Results of using L-ornitin-L-aspartate in the treatment of hepatic encephalopathy in liver transplantation

Transplantologiya The Russian Journal of Transplantation ◽

10.23873/2074-0506-2021-13-3-235-247 ◽

2021 ◽

Vol 13 (3) ◽

pp. 235-247

Author(s):

S. E. Voskanyan ◽

E. V. Naydenov ◽

A. I. Artemev ◽

D. A. Zabezhinskiy ◽

K. K. Gubarev ◽

...

Keyword(s):

Liver Transplantation ◽

Hepatic Encephalopathy ◽

Length Of Stay ◽

Cognitive Functions ◽

Comparison Group ◽

Hospital Length ◽

Main Group ◽

Stage Ii ◽

Hospital Length Of Stay ◽

Preoperative Period

The aim was to study the results of using various treatment regimens for hepatic encephalopathy for patients with liver cirrhosis before and after liver transplantation and the effect on the incidence and severity of hepatic encephalopathy in the perioperative period, and on the posttransplantation course.Material and methods. Fifty four patients with cirrhosis of various etiologies and the presence of significant hepatic encephalopathy undergoing living donor liver transplantation were included in the study. In the comparison group, patients took lactulose and rifaximin. In the main group, patients took lactulose and rifaximin in combination with L-ornithine-L-aspartate in the preoperative period, and L-ornithine-L-aspartate after liver transplantation for 5 days.Results. The use of L-ornithine-L-aspartate in the complex therapy of hepatic encephalopathy led to significantly reduced time of performing the Number Connection Test, the improvement of cognitive functions in patients by the Montreal Cognitive Assessment, a decreased incidence of stage II–III hepatic encephalopathy and an increased incidence of stage 0-I hepatic encephalopathy in the preoperative period. In the postoperative period, patients of the main group showed a rapid decrease in the severe stages of hepatic encephalopathy (stage II–III) towards less severe forms (stage 0–I) on the 3rd, 5th and 7th days after liver transplantation, and also a faster recovery of cognitive functions, an earlier adequate recovery of consciousness, muscle tone, an earlier possibility of extubation, a shorter length of stay in the intensive care unit, and a decreased postoperative hospital length of stay relatively to the patients of the comparison group.Conclusion. The use of L-ornithine-L-aspartate in the combination therapy for hepatic encephalopathy in the peritransplantation period leads to a significant decrease of the incidence and severity of hepatic encephalopathy, accelerates rehabilitation of patients, reduces postoperative hospital length of stay.

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Effect of Exercises in Water and Land on Balance and Cognitive Functions in Elderly and Old Persons

Reabilitacijos mokslai slauga kineziterapija ergoterapija ◽

10.33607/rmske.v1i18.746 ◽

2019 ◽

Vol 1 (18) ◽

Author(s):

Remigija Dekaminavičiūtė ◽

Vilma Dudonienė

Keyword(s):

Cognitive Functions ◽

Elderly Women ◽

Dynamic Balance ◽

Exercise Program ◽

Static Balance ◽

Trail Making Test ◽

Exercise Programs ◽

Balance Test ◽

Trail Making ◽

Better Than

Research background. Aging constantly manifests itself not only in physiological changes, but also in cognitive ones. Exercise programs for elderly have been created aiming at avoiding risk of falling, but there is little known about changes in cognitive functions under the eﬀect of exercise. The aim was to evaluate the eﬀect of water-based and land-based exercises on balance and cognitive functions in elderly women and men. Methods. The dynamic balance of study participants (n = 32) was evaluated using Timed Up & Go Test, the static balance was evaluated with a 4-position Static Balance Test and the cognitive functions were evaluated with Six-Item Cognitive Impairment Test, the Cognitive Failures Questionnaire and the Trail Making Test. The participants were randomly divided in two groups: water exercise and land-based exercise. Results. After 8 weeks of exercise in water and on land, static and dynamic balance and cognitive functions improved in both groups (p < 0.05), no statistically signifcant diﬀerence was found between the groups except for the trail making test, which was performed more quickly by subjects who attended exercise in water. After the exercise program, the men’s dynamic and static balance (while standing in the tandem position) were better than women’s, but women’s standing on one leg position was better than that of men’s (p < 0.05). Conclusion. There were no statistically signifcant diﬀerences in cognitive function between men and women after intervention. After both exercise programs, dynamic and static balance (in the tandem position) in men were better (p < 0.05) than those in women, standing on one leg but women’s position was statistically signifcantly better than that of men’s.Keywords: exercise program in water and land-based, static and dynamic balance, cognitive functions.

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Prevalence and Pattern of Neurocognitive Impairment in Nigerians with Stages 3 to 5 Chronic Kidney Disease

ISRN Neurology ◽

10.1155/2013/374890 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

U. E. Williams ◽

M. O. Owolabi ◽

A. Ogunniyi ◽

E. O. Ezunu

Keyword(s):

Chronic Kidney Disease ◽

Cognitive Impairment ◽

Kidney Disease ◽

Trail Making Test ◽

Community Screening ◽

Cognitive Domains ◽

Gault Formula ◽

Negative Effect ◽

Trail Making ◽

Multiple Domains

Background. Cognitive impairment with its negative effect on quality of life has been reported in chronic kidney disease (CKD). The paucity of the literature on cognitive impairment in Africans with CKD prompted this study. Objectives. To determine the frequency and pattern of cognitive impairment in patients with stages 3 to 5 CKD. Methods. We studied 79 consecutive consenting adults with a National Kidney Foundation (NKF) stage 3 to 5 CKD based on their estimated glomerular filtration rate using the Cockcroft-Gault formula. The controls consisted of healthy demographically matched subjects. Community screening instrument for dementia (CSI’D), trail making test A (TMTA), and trail making test B (TMTB) were used for cognitive assessment. Results. More CKD patients had cognitive impairment compared with controls using CSI’D (51.9% versus 2.5%, P<0.001); TMTA (53.2% versus 0%, P<0.001); and TMTB (40% versus 0%, P<0.001). The odds of having cognitive impairment increased in the presence of CKD when assessed using CSI’D (OR = 2.026; CI = 1.607–2.555); TMTA (OR = 3.13; CI = 2.40–4.09) and TMTB (OR = 3.22; CI = 2.42–4.25). CKD patients performed poorer on tests of executive function TMTA (P<0.001) and TMTB (P<0.001) while CSI’D showed significantly lower scores on multiple cognitive domains. Conclusions. Significant cognitive impairment in multiple domains exists among Nigerians with CKD.

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Ethics of Liver Transplantation: The Role of the Anesthesiologist

Seminars in Cardiothoracic and Vascular Anesthesia ◽

10.1177/1089253218763815 ◽

2018 ◽

Vol 22 (2) ◽

pp. 229-236 ◽

Cited By ~ 1

Author(s):

James M. West

Keyword(s):

Liver Transplantation ◽

Organ Transplant ◽

Donation After Circulatory Death ◽

Donor Liver Transplantation ◽

Definition Of Death ◽

Life Saving ◽

History Of ◽

Definition Of ◽

Related Liver Disease ◽

Circulatory Death

Anesthesiologists have clearly established their place in the history of medical ethics. Our involvement goes back to 1966 when Henri Beecher published his landmark paper on research and informed consent. Participation in the ethics of transplantation is no less important than our previous work. Organ transplant has been life saving for many but also has given rise to many misunderstandings not just from the public but also among our own colleagues. These include methods of allocation and donation, the role that affluence may play in receiving an organ, the definition of death and donation after circulatory death. As perioperative physicians and important members of the transplant team, anesthesiologists are expected to participate in all aspects of care including ethical judgments. This article discusses some of the issues that seem to cause the most confusion and angst for those of us involved in both liver transplantation and in the procurement of organs. It will discuss the definition of death, donation after circulatory death, the anesthesiologists’ role on the selection committee, living donor liver transplantation, and transplantation of patients with alcohol-related liver disease.

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Applicability of the Test of Variables of Attention – T.O.V.A in Brazilian adults

Dementia & Neuropsychologia ◽

10.1590/1980-57642018dn12-040009 ◽

2018 ◽

Vol 12 (4) ◽

pp. 394-401 ◽

Cited By ~ 4

Author(s):

Cláudia M. Memória ◽

Henrique C.S. Muela ◽

Natália C. Moraes ◽

Valéria A. Costa-Hong ◽

Michel F. Machado ◽

...

Keyword(s):

Performance Test ◽

Digit Span ◽

Screening Tests ◽

Trail Making Test ◽

Digit Symbol ◽

Cognitive Screening ◽

Or Education ◽

Attentional Processes ◽

Trail Making ◽

State Examination

ABSTRACT The functioning of attention is complex, a primordial function in several cognitive processes and of great interest to neuropsychology. The Test of Variables of Attention (T.O.V.A) is a continuous computerized performance test that evaluates some attention components such as response time to a stimulus and errors due to inattention and impulsivity. Objective: 1) To evaluate the applicability of T.O.V.A in Brazilian adults; 2) To analyze the differences in performance between genders, age ranges, and levels of education; 3) To examine the association between T.O.V.A variables and other attention and cognitive screening tests. Methods: The T.O.V.A was applied to 63 healthy adults (24 to 78 years of age) who also underwent the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Digit Span and Digit Symbol (Wechsler Intelligence Scale for Adults – WAIS-III) and the Trail Making Test. Results: the T.O.V.A was little influenced by age or education, but was influenced by gender. The correlations between some T.O.V.A variables and the Digit Symbol and Trail Making test were weak (r-values between 0.2 and 0.4), but significant (p<0.05). There was no correlation with the Digit Span test. Conclusion: The T.O.V.A showed good applicability and proved adequate for evaluating attentional processes in adults.

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