title: Alterations in cerebral white matter and neuropsychology in patients with cirrhosis and falls.
abstract: OBJECTIVE
  Falls are frequent in patients with cirrhosis but underlying mechanisms are unknown. The aim was to determine the neuropsychological, neurological and brain alterations using magnetic resonance-diffusion tensor imaging (MR-DTI) in cirrhotic patients with falls.
  
  
  METHODS
  Twelve patients with cirrhosis and falls in the previous year were compared to 9 cirrhotic patients without falls. A comprehensive neuropsychological and neurological evaluation of variables that may predispose to falls included: the Mini-Mental State Examination, Psychometric Hepatic Encephalopathy Score (PHES), Parkinson's Disease-Cognitive Rating Scale, specific tests to explore various cognitive domains, Unified Parkinson's Disease Rating Scale to evaluate parkinsonism, scales for ataxia and muscular strength, and electroneurography. High-field MR (3T) including DTI and structural sequences was performed in all patients.
  
  
  RESULTS
  The main neuropsychological findings were impairment in PHES (p = 0.03), Parkinson's Disease-Cognitive Rating Scale (p = 0.04) and in executive (p<0.05) and visuospatial-visuoconstructive functions (p<0.05) in patients with falls compared to those without. There were no statistical differences between the two groups in the neurological evaluation or in the visual assessment of MRI. MR-DTI showed alterations in white matter integrity in patients with falls compared to those without falls (p<0.05), with local maxima in the superior longitudinal fasciculus and corticospinal tract. These alterations were independent of PHES as a covariate and correlated with executive dysfunction (p<0.05).
  
  
  CONCLUSIONS
  With the limitation of the small sample size, our results suggest that patients with cirrhosis and falls present alterations in brain white matter tracts related to executive dysfunction. These alterations are independent of PHES impairment.
authors: Neuroradiology Unit, Department of Radiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors: Beatriz
authors: B
authors: Gómez-Ansón
authors: Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Escola Universitària d'Infermeria EUI-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
authors: Eva
authors: E
authors: Román
authors: Movement Disorders Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors: Ramón
authors: R
authors: Fernández de Bobadilla
authors: INNDACYT, CR, Sant Feliu de Llobregat, Spain.
authors: Patricia
authors: P
authors: Pires-Encuentra
authors: Neuromuscular Disorders Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Valencia, Spain.
authors: Jordi
authors: J
authors: Díaz-Manera
authors: Neuroradiology Unit, Department of Radiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors: Fidel
authors: F
authors: Núñez
authors: Movement Disorders Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors: Saül
authors: S
authors: Martinez-Horta
authors: Port d'Informació Científica (PIC), Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Institut de Física d'Altes Energies (IFAE), Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.
authors: Yolanda
authors: Y
authors: Vives-Gilabert
authors: Movement Disorders Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.
authors: Javier
authors: J
authors: Pagonabarraga
authors: Movement Disorders Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.
authors: Jaume
authors: J
authors: Kulisevsky
authors: Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
authors: Juan
authors: J
authors: Cordoba
authors: Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
authors: Carlos
authors: C
authors: Guarner
authors: Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
authors: Germán
authors: G
authors: Soriano
mesh_terms: D000058:Accidental Falls; D000368:Aged; D016880:Anisotropy; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D066127:White Matter / Q000473:pathology*