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The etiology of cirrhosis is a strong determinant of brain reserve: A multimodal magnetic resonance imaging study
Author(s) -
Ahluwalia Vishwadeep,
Wade James B.,
Moeller F. Gerard,
White Melanie B.,
Unser Ariel B.,
Gavis Edith A.,
Sterling Richard K.,
Stravitz R. Todd,
Sanyal Arun J.,
Siddiqui Mohammad S.,
Puri Puneet,
Luketic Velimir,
Heuman Douglas M.,
Fuchs Michael,
Matherly Scott,
Bajaj Jasmohan S.
Publication year - 2015
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.24163
Subject(s) - medicine , hepatic encephalopathy , magnetic resonance imaging , cognitive reserve , cirrhosis , context (archaeology) , cognition , psychiatry , radiology , cognitive impairment , paleontology , biology
Poor brain reserve in alcoholic cirrhosis could worsen insight regarding disease severity and increase the patients' vulnerability toward further deterioration. The aim of this study was to analyze brain reserve in abstinent alcoholic cirrhotic (Alc) patients compared to nonalcoholic cirrhotic (Nalc) patients in the context of hepatic encephalopathy (HE) and to evaluate relative change in brain reserve between groups over time and before and after elective transjugular intrahepatic portosystemic shunt (TIPS) placement. The cross‐sectional study included 46 Alc and 102 Nalc outpatients with or without HE. Cognitive tests were followed by magnetic resonance imaging (MRI), including proton magnetic resonance spectroscopy ( 1 H‐MRS), diffusion tensor imaging, and T1‐weighted imaging. The prospective study included 1 H‐MRS on a subset of 10 patients before and after TIPS placement. Another subset of 26 patients underwent 1 H‐MRS at least 1 year apart. For the cross‐sectional study, Alc patients were worse on cognitive tests than Nalc patients. MRI results suggest a greater effect of hyperammonemia, brain edema, and significantly higher cortical damage in Alc as compared to Nalc patients. The effect of HE status on cognitive tests and brain reserve was more marked in the Nalc than in the Alc group. For the TIPS study, Nalc patients showed a greater adverse relative change after TIPS compared to the Alc group. At 1‐year follow‐up, both groups remained stable between the 2 visits. However, Alc patients continued to show poor brain reserve compared to Nalc patients over time. In conclusion, Alc patients, despite abstinence, have a poor brain reserve, whereas Nalc patients have a greater potential for brain reserve deterioration after HE and TIPS. Information regarding the brain reserve in cirrhosis could assist medical teams to refine their communication and monitoring strategies for different etiologies. Liver Transpl 21:1123℃1132, 2015 . © 2015 AASLD.