A review of cognitive impairment and cerebral metabolite abnormalities in patients with hepatitis C infection.
Numerous studies have reported associations between chronic hepatitis C virus (HCV) infection and fatigue, depression and impairments in health-related quality of life, which are independent of the severity of liver disease. Although there are a large number of potential explanations for these symptoms, including a history of substance abuse and associated personality types, or the effect of the diagnosis of HCV infection itself, there has been recent interest in the possibility of a biological effect of HCV infection on cerebral function. There is emerging evidence of mild, but significant neurocognitive impairment in HCV infection, which cannot be wholly attributed to substance abuse, co-existent depression or hepatic encephalopathy. Impairments are predominantly in the domains of attention, concentration and information processing speed. Furthermore, in-vivo cerebral magnetic resonance spectroscopy studies in patients with hepatitis C and normal liver function have reported elevations in cerebral choline-containing compounds and reductions in N-acetyl aspartate, suggesting that a biological mechanism may underlie the cognitive findings. The recent detection of HCV genetic sequences in post-mortem brain tissue raises the intriguing possibility that HCV infection of the central nervous system may be related to the reported neuropsychological symptoms and cognitive impairment.
Forton
Daniel M
DM
Liver Unit, Division of Medicine, Faculty of Medicine, Imperial College London, St Mary's Hospital Campus, London, UK. d.forton@imperial.ac.uk
Allsop
Joanna M
JM
Cox
I Jane
IJ
Hamilton
Gavin
G
Wesnes
Keith
K
Thomas
Howard C
HC
Taylor-Robinson
Simon D
SD
D001921:Brain / Q000378:metabolism*; D003072:Cognition Disorders / Q000821:virology*; D003863:Depression / Q000821:virology; D005221:Fatigue / Q000821:virology; D015658:HIV Infections / Q000523:psychology; D019698:Hepatitis C, Chronic / Q000378:metabolism / Q000523:psychology*; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D011788:Quality of Life