title: Neuropsychological abnormalities in cirrhosis include learning impairment.
abstract: OBJECTIVE
  Minimal hepatic encephalopathy is a neurocognitive disorder secondary to liver failure that is characterized by a pattern of subcortical impairment. The most conspicuous neuropsychological abnormalities are on attention and psychomotor tests; memory has been inconsistently implicated. We designed a study to assess the presence of memory abnormalities in cirrhotic patients and the effects of liver transplantation.
  
  
  METHODS
  Ninety-seven cirrhotics without overt hepatic encephalopathy underwent neuropsychological assessment, including the Auditory Verbal Learning Memory Test. The results were compared to those of healthy controls (n=75) and the assessment was repeated at one year of follow-up (n=33) or after liver transplantation (n=23).
  
  
  RESULTS
  Cirrhotic patients exhibited multiple neuropsychological abnormalities, including several disturbances of the Auditory Verbal Learning memory test: learning, long-term memory and recognition. Abnormalities of long-term memory and recognition were corrected after adjusting for learning impairment. Memory abnormalities correlated to attention impairment and to parameters of liver function. Neuropsychological indexes following liver transplantation did not differ from controls. Repeated testing did not have a major effect on neuropsychological tests in healthy subjects and in non-transplanted cirrhotics.
  
  
  CONCLUSIONS
  Learning impairment is present in cirrhotic patients with neuropsychological abnormalities. This abnormality is consistent with attention deficit secondary to minimal hepatic encephalopathy.
authors.affiliation: Servei de Medicina Interna-Hepatologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Ortiz
authors.forename: Juan
authors.initials: J
authors.lastname: Córdoba
authors.forename: Carlos
authors.initials: C
authors.lastname: Jacas
authors.forename: Montserrat
authors.initials: M
authors.lastname: Flavià
authors.forename: Rafael
authors.initials: R
authors.lastname: Esteban
authors.forename: Jaume
authors.initials: J
authors.lastname: Guardia
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007859:Learning Disabilities / Q000209:etiology* / Q000523:psychology; D008103:Liver Cirrhosis / Q000150:complications / Q000523:psychology* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008568:Memory / Q000502:physiology*; D008875:Middle Aged; D009483:Neuropsychological Tests; D011379:Prognosis; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires