Verbal memory is impaired in patients with cirrhosis
Alok Madan, Kelli L. Netson, Amy L. Meidinger, Joslyn M McCoy, Jeffery J. Borckardt, Brendan M. McGuire, Adrian H. Thurstin, Beverly A. Bush
Background: Sub-clinical hepatic encephalopathy is a commonly recognized cognitive sequelae of cirrhosis and is associated with normal neurological and mental status exams but impaired performance on neuropsychological measures. Cognitive slowing and impairments in executive functioning are frequently noted; however, there is debate in the literature regarding the degree of memory dysfunction in patients with sub-clinical hepatic encephalopathy. This study aimed to evaluate memory functioning in patients with sub-clinical hepatic encephalopathy. Method: Individuals with cirrhosis and no overt hepatic encephalopathy who presented for assessment for possible liver transplant to a large academic medical center in the South between January 2002 and July 2003 were randomly selected for analysis. In this retrospective analysis, a sample of convenience of 125 individuals comprised the three diagnostic categories: alcohol (ETOH) induced- (n=40), hepatitis C virus (HCV) without ETOH induced- (n=42), and non-ETOH/non-HCV induced-cirrhosis (n=43). Results: Fortyeight percent of study sample reported difficulties with memory functioning within the past year, independent of disease etiology. Compared to normative data, individuals with all three cirrhosis etiologies performed significantly worse than their healthy peers across neuropsychological measures of verbal memory functioning. Multivariate analyses revealed that individuals with ETOH-induced cirrhosis performed significantly worse than individuals with non-ETOH/non-HCV-induced cirrhosis on a specific measure of learning and memory. Conclusions: Cirrhosis is associated with impaired memory functioning regardless of underlying liver disease etiology. It appears that that sustained periods of excessive ETOH consumption result in greater impairments in memory functioning than hepatic insufficiency alone. Impairments in memory functioning among individuals with cirrhosis have the potential to negatively affect receipt of medical information, compromising compliance with treatment recommendations and negatively affecting pre- and post-transplantation outcomes.