Breakfast improves cognitive function in cirrhotic patients with cognitive impairment.
BACKGROUND
Cognitive disturbances are relatively common in patients with liver disease. High protein load precipitates hepatic encephalopathy in cirrhotic patients. Minimal hepatic encephalopathy (MHE) is a prevalent neurocognitive complication of cirrhosis.


OBJECTIVE
Because the influence of nutritional factors on the progression of cognitive impairment has not been explored in depth, this study aimed to investigate the effect on cognition of acute metabolic changes induced by breakfast consumption.


METHODS
Twenty-one subjects (10 women) with Child A cirrhosis and 21 age- and sex-matched healthy controls were enrolled. Patients and controls were divided into 2 groups: those receiving a breakfast of 500 kcal and 21 g protein and those receiving no breakfast. Serum ammonia concentrations and cognitive functions were studied (Mindstreams; NeuroTrax, Fresh Meadows, NY) before and 2 h after breakfast. A mixed model was used to analyze the data.


RESULTS
At baseline, cirrhotic patients had significantly lower total scores and significantly lower subscores (P < 0.015 global cognitive score) in 4 of 7 cognitive categories, which is indicative of MHE. Patients with hyperammonemia (>85 mug/dL) scored significantly lower for attention than did patients with normal serum ammonia concentrations (P < 0.003). After 2 h, MHE patients and controls responded differently to breakfast consumption with regard to attention and executive functions (P < 0.003 and P < 0.04, respectively). Although patients' scores improved after breakfast consumption, despite an increase in serum ammonia, healthy controls who continued to fast performed better.


CONCLUSIONS
Chronic hyperammonemia may negatively affect attention. Eating breakfast improves attention and executive functions of patients with MHE. Prolonged periods of starvation may be partly responsible for these changes. This trial was registered at clinicaltrials.gov as NCT01083446.
Vaisman
Nachum
N
Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. vaisman@tasmc.health.gov.il
Katzman
Helena
H
Carmiel-Haggai
Michal
M
Lusthaus
Michal
M
Niv
Eva
E
D000328:Adult; D000339:Affect; D000368:Aged; D000369:Aged, 80 and over; D000641:Ammonia / Q000097:blood; D001288:Attention / Q000502:physiology; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000178:diet therapy* / Q000209:etiology; D004435:Eating / Q000502:physiology*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000178:diet therapy* / Q000473:pathology / Q000523:psychology; D008297:Male; D008568:Memory; D008606:Mental Processes; D008875:Middle Aged; D009048:Motor Skills; D012016:Reference Values; D013060:Speech; D013217:Starvation / Q000150:complications
D000641:Ammonia