Cognitive impairment in liver transplant candidates: The role of blood ammonia level and three-point evaluation of brain MRI.

BACKGROUND

Cognitive impairment (CI) is common in patients with alcohol-use disorder (AUD)-related liver cirrhosis, especially those awaiting liver transplantation (LT). There are conflicting results in terms of the role of hepatic encephalopathy (HE) in CI development and persistence.

OBJECTIVES

This study investigated the impact of hyperammonemia on CI and evaluated the role of routine magnetic resonance imaging (MRI) in detecting CI among patients with AUD-related cirrhosis listed for LT at a single center.

MATERIAL AND

METHODS

Fifty-two adults (36 males, 69%) with AUD-related liver cirrhosis (mean age: 51 ±11 years; mean Model for End-Stage Liver Disease (MELD) score 16 ±6) were evaluated. Cognitive function was assessed using the Addenbrooke's Cognitive Examination III (ACE-III), with scores below 82 indicating probable dementia. Magnetic resonance imaging evaluations focused on cortical-subcortical atrophy, vascular-origin changes, and chronic HE.

RESULTS

Magnetic resonance imaging revealed HE-related changes in 38 patients (73%), vascular-origin changes in 32 patients (62%), and cortical-subcortical atrophy in 15 patients (29%). Cognitive impairment was present in 46 patients (88%), with 30 (58%) suspected of having dementia. Patients with MRI evidence of HE scored lower in the ACE III language subdomain (p = 0.032) and tended toward a higher Child-Pugh classification (p = 0.083). No significant differences were found in ACE-III results or clinical data between patients with and without vascular-origin changes or cortical-subcortical atrophy. Additionally, no correlations were observed between radiological findings, ammonia levels, ACE-III scores, and liver-related mortality.

CONCLUSIONS

These findings reveal a high prevalence of CI and significant MRI abnormalities in AUD patients awaiting LT. Further studies are needed to clarify the role of routine MRI in detecting cognitive deficits.