title: Hepatitis C and cognitive impairment in a cohort of patients with mild liver disease.
abstract: Patients with chronic hepatitis C virus (HCV) infection frequently report fatigue, lassitude, depression, and a perceived inability to function effectively. Several studies have shown that patients exhibit low quality-of-life scores that are independent of disease severity. We therefore considered whether HCV infection has a direct effect on the central nervous system, resulting in cognitive and cerebral metabolite abnormalities. Twenty-seven viremic patients with biopsy-proven mild hepatitis due to HCV and 16 patients with cleared HCV were tested with a computer-based cognitive assessment battery and also completed depression, fatigue, and quality-of-life questionnaires. The HCV-infected patients were impaired on more cognitive tasks than the HCV-cleared group (mean [SD]: HCV-infected, 2.15 [1.56]; HCV-cleared, 1.06 [1.24]; P =.02). A factor analysis showed impairments in power of concentration and speed of working memory, independent of a history of intravenous drug usage (IVDU), depression, fatigue, or symptom severity. A subgroup of 17 HCV-infected patients also underwent cerebral proton magnetic resonance spectroscopy (1H MRS). The choline/creatine ratio was elevated in the basal ganglia and white matter in this group. Patients who were impaired on 2 or more tasks in the battery had a higher mean choline/creatine ratio compared with the unimpaired patients. In conclusion, these preliminary results demonstrate cognitive impairment that is unaccounted for by depression, fatigue, or a history of IVDU in patients with histologically mild HCV infection. The findings on MRS suggest that a biological cause underlies this abnormality.
authors.affiliation: Hepatology Section, Division of Medicine A, Faculty of Medicine, Imperial College, St Mary's Hospital, London, UK. d.forton@ic.ac.uk
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Forton
authors.forename: Howard C
authors.initials: HC
authors.lastname: Thomas
authors.forename: Christine A
authors.initials: CA
authors.lastname: Murphy
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Allsop
authors.forename: Graham R
authors.initials: GR
authors.lastname: Foster
authors.forename: Janice
authors.initials: J
authors.lastname: Main
authors.forename: Keith A
authors.initials: KA
authors.lastname: Wesnes
authors.forename: Simon D
authors.initials: SD
authors.lastname: Taylor-Robinson
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000378:metabolism; D002794:Choline / Q000378:metabolism; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism / Q000523:psychology; D015331:Cohort Studies; D003401:Creatine / Q000378:metabolism; D005260:Female; D006526:Hepatitis C / Q000523:psychology*; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008568:Memory; D008875:Middle Aged; D009483:Neuropsychological Tests; D012720:Severity of Illness Index; D014766:Viremia / Q000523:psychology
chemical_list: D003401:Creatine; D002794:Choline