title: Altered postural control and stability in cirrhotic patients with minimal hepatic encephalopathy correlate with cognitive deficits.
abstract: Cognitive dysfunction in cirrhotic patients with minimal hepatic encephalopathy (MHE) is associated with falls. Alterations in postural control and stability could contribute to increase falls risk in these patients. We aimed to assess whether postural control and direction-specific limits of stability are altered in cirrhotic patients with MHE compared to patients without MHE and controls. We also assessed if alterations in postural control correlate with neurological impairment and/or blood biomarkers.
  
  
  
  Posturography analysis, attention Stroop test and bimanual and visuo-motor coordination tests were performed in 18 controls, 19 patients with cirrhosis without MHE and 17 with MHE, diagnosed by PHES. Posturography was assessed by NedSVE®/IBV system under four sensory conditions. Limits of stability and rhythmic weight-shifting tests were also performed. Blood ammonia and serum interleukins were also measured. Falls were assessed after 12-24 months follow-up.
  
  
  
  MHE patients show impaired balance, mainly on unstable surface with eyes open, with longer reaction and confinement times and lower success in Limits of Stability test compared to patients without MHE. Performance in attention and motor coordination tests correlated with most posturography parameters alterations. Logistic regression analysis shows that posturography parameters and bimanual coordination test are good predictors of falls.
  
  
  
  Balance patterns and limits of stability in MHE patients are impaired compared to patients without MHE and controls. This seems to contribute to a higher falls risk. Attention and motor coordination deficits could contribute to balance impairment in patients with MHE.
authors.affiliation: Instituto de Investigación Sanitaria-INCLIVA, Valencia, Spain.|Laboratory of Neurobiology, Centro Investigación Príncipe Felipe de Valencia, Valencia, Spain.
authors.forename: Amparo
authors.initials: A
authors.lastname: Urios
authors.affiliation: Instituto de Investigación Sanitaria-INCLIVA, Valencia, Spain.
authors.forename: Alba
authors.initials: A
authors.lastname: Mangas-Losada
authors.affiliation: Instituto de Investigación Sanitaria-INCLIVA, Valencia, Spain.|Laboratory of Neurobiology, Centro Investigación Príncipe Felipe de Valencia, Valencia, Spain.
authors.forename: Carla
authors.initials: C
authors.lastname: Gimenez-Garzó
authors.affiliation: Servicio de Digestivo, Hospital Arnau de Vilanova, Valencia, Spain.
authors.forename: Olga
authors.initials: O
authors.lastname: González-López
authors.affiliation: Servicio de Digestivo, Hospital Arnau de Vilanova, Valencia, Spain.
authors.forename: Remedios
authors.initials: R
authors.lastname: Giner-Durán
authors.affiliation: Unidad de Digestivo, Hospital Clínico de Valencia, Departamento Medicina, Universidad de Valencia, Valencia, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Serra
authors.affiliation: Servicio de Daño, Cerebral del Hospital Valencia al Mar, Valencia, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Noe
authors.affiliation: Laboratory of Neurobiology, Centro Investigación Príncipe Felipe de Valencia, Valencia, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Felipo
authors.affiliation: Instituto de Investigación Sanitaria-INCLIVA, Valencia, Spain.|Departamento de Patología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain.
authors.forename: Carmina
authors.identifier: 0000-0002-4740-4788
authors.initials: C
authors.lastname: Montoliu
mesh_terms: D000058:Accidental Falls; D000641:Ammonia / Q000097:blood; D001288:Attention; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D007378:Interleukins / Q000097:blood; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010808:Physical Examination; D004856:Postural Balance; D011237:Predictive Value of Tests; D011594:Psychometrics; D011597:Psychomotor Performance; D012307:Risk Factors; D012678:Sensation Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D057190:Stroop Test
chemical_list: D007378:Interleukins; D000641:Ammonia
keywords: falls; limits of stability; minimal hepatic encephalopathy; postural control