Background & Aims

Patients with cirrhosis are growing older. The overlap between minimal hepatic encephalopathy (MHE) and predementia mild cognitive impairment (MCI) could affect quality of life (QOL). We investigated the performance of elderly patients with cirrhosis on tests for MHE and MCI and their effects on QOL.

Methods

We recruited outpatients with cirrhosis (n = 109) and without cirrhosis (controls, n = 100), 65 years or older, at 4 centers (derivation cohort). All study participants were assessed for psychometric hepatic encephalopathy score (PHES), EncephalApp score, and QOL. MCI was tested in patients with cirrhosis using the repeatable battery for assessment of neuropsychological status and assigned to the following groups: unimpaired, MCI only, MHE only, and MCI+MHE. We created adjusted norms to detect MHE using PHES and EncephalApp scores from the controls. Findings were validated using data from a separate cohort of 77 patients with cirrhosis (mean age, 69.49 ± 4.36 y; 72% men) at the same study sites.

Results

Controls were older but were more educated, performed better cognitively, and had better QOL. Among patients with cirrhosis, age, education, model for end-stage liver disease score, EncephalApp score, and QOL were similar, but PHES and repeatable battery for assessment of neuropsychological status differed among sites. In the derivation cohort, the presence of MHE, with or without MCI, was associated with poor QOL, which was lowest in the MCI+MHE group. When we adjusted for age, sex, and education, 49% of patients with cirrhosis had MHE based on the EncephalApp and 8% had MHE based on the PHES. A similar pattern (49% MHE based on EncephalApp and 6% MHE based on PHES) was found in a validation cohort.

Conclusions

In a multicenter study of patients with cirrhosis (>65 y) and controls, the presence of MHE, regardless of MCI, was associated with poor cognition and QOL. We created adjusted norms that defined the high sensitivity of EncephalApp for the detection of MHE in older individuals and validated it in a separate cohort.

中文翻译：

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轻度肝性脑病和轻度认知障碍会恶化老年肝硬化患者的生活质量。

背景与目标

肝硬化患者的年龄越来越大。轻度肝性脑病 (MHE) 和痴呆前期轻度认知障碍 (MCI) 之间的重叠可能会影响生活质量 (QOL)。我们调查了老年肝硬化患者在 MHE 和 MCI 测试中的表现及其对 QOL 的影响。

方法

我们在 4 个中心（派生队列）招募了 65 岁或以上的有肝硬化（n = 109）和无肝硬化（对照组，n = 100）的门诊患者。所有研究参与者都接受了心理测量肝性脑病评分 (PHES)、EncephalApp 评分和 QOL 的评估。MCI 在肝硬化患者中进行了测试，使用可重复电池评估神经心理状态，并将其分配到以下组：未受损、仅 MCI、仅 MHE 和 MCI+MHE。我们创建了调整后的规范，以使用来自对照的 PHES 和 EncephalApp 分数来检测 MHE。使用来自同一研究地点的 77 名肝硬化患者（平均年龄，69.49 ± 4.36 岁；72% 男性）的单独队列的数据验证了结果。

结果

对照组年龄较大，但受过更多教育，认知表现更好，生活质量更好。在肝硬化患者中，年龄、教育程度、终末期肝病评分模型、EncephalApp 评分和 QOL 相似，但 PHES 和用于评估神经心理状态的可重复电池因地点而异。在推导队列中，无论有无 MCI，MHE 的存在都与较差的 QOL 相关，这在 MCI+MHE 组中最低。当我们调整年龄、性别和教育时，49% 的肝硬化患者有基于 EncephalApp 的 MHE，8% 有基于 PHES 的 MHE。在验证队列中发现了类似的模式（基于 EncephalApp 的 MHE 为 49%，基于 PHES 的 MHE 为 6%）。

结论

在一项针对肝硬化患者（>65 岁）和对照组的多中心研究中，MHE 的存在，无论 MCI 如何，都与认知能力和 QOL 差相关。我们创建了调整后的规范，定义了 EncephalApp 在检测老年人 MHE 方面的高灵敏度，并在单独的队列中对其进行了验证。