title: Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy.
abstract: Minimal hepatic encephalopathy (MHE) has a negative effect on patients' daily functioning. Thus far, no study has investigated the effect of treatment-related improvement in cognitive functions on health-related quality of life (HRQOL). We measured psychometric performance by number and figure connection tests parts A and B, picture completion, and block design tests and HRQOL by the Sickness Impact Profile (SIP) of 90 patients with cirrhosis on inclusion into the study and 3 months later. A Z score less than -2 on the neuropsychological (NP) tests was considered abnormal. Sixty-one (67.7%) patients had MHE. They were randomly assigned in a 1:1 ratio to receive treatment (lactulose) for 3 months (n=31) or no treatment (n=30) in a nonblinded design. The mean number of abnormal NP tests decreased significantly in patients in the treated group (baseline, 2.74 [95% CI 2.40-3.08]; after 3 months, .75 [95% CI .36-1.16]) compared with patients in the untreated group (baseline, 2.47 [95% CI 2.19-2.74]; after 3 months, 2.55 [95% CI 2.16-2.94]); multivariate analysis of variance (MANOVA) for time and treatment, P=0.001. The mean total SIP score improved among patients in the treated group (baseline, 10.39 [95% CI 9.36-11.43]; after 3 months, 3.77 [95% CI 2.52-5.02]) compared with patients in the untreated group (baseline, 10.36 [95% CI 8.98-11.73]; after 3 months, 10.39 [95% CI 8.36-12.42]); MANOVA for time and treatment, P=0.002. Improvement in HRQOL was related to the improvement in psychometry.
  
  
  CONCLUSIONS
  Treatment with lactulose improves both cognitive function and HRQOL in patients with cirrhosis who have MHE.
authors.affiliation: Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Srinivasa
authors.initials: S
authors.lastname: Prasad
authors.forename: Radha K
authors.initials: RK
authors.lastname: Dhiman
authors.forename: Ajay
authors.initials: A
authors.lastname: Duseja
authors.forename: Yogesh K
authors.initials: YK
authors.lastname: Chawla
authors.forename: Arpita
authors.initials: A
authors.lastname: Sharma
authors.forename: Ritesh
authors.initials: R
authors.lastname: Agarwal
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000368:Aged; D003071:Cognition / Q000187:drug effects*; D005260:Female; D005765:Gastrointestinal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D006501:Hepatic Encephalopathy / Q000188:drug therapy* / Q000209:etiology / Q000523:psychology*; D006801:Humans; D007792:Lactulose / Q000494:pharmacology / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D011594:Psychometrics; D011597:Psychomotor Performance / Q000187:drug effects; D011788:Quality of Life / Q000523:psychology*; D018434:Sickness Impact Profile
chemical_list: D005765:Gastrointestinal Agents; D007792:Lactulose