Clinical-neuropsychological features of the hepatic encephalopathy formation

Abstract

35 patients with different stages of the hepatic encephalopathy on the background of the chronic hepatitis at the age of 45.2 ± 5.8 years were examined. The investigation complex included neurological, psychometric (numbers connection test, SDMT number-symbol test, Schulte tables, Montreal cognitive function evaluation scale, HADS scale), and instrumental (EEG and MRI of the brain) examination. The findings showed that early clinical manifestation of hepatic encephalopathy included mild cognitive impairments, sleep disturbances (initial manifestations of impaired consciousness), emotional disorders (asthenic syndrome, anxiety) and impaired fine motor movements (changes of handwriting and fine coordination). According of the psychometric testing results the signs of the hepatic encephalopathy latent stage were detected including an impairment of the attention (due to numbers connection test results), a decrease of the cognitive processes speed and a violation of visual short-term memory (SDMT), difficulty in delayed reproduction of the information, a violation of fine motor movements (change handwriting). Disturbance of the brain bioelectrical activity was characterized by slowing the frequency of the alpha rhythm, an increase in the slow-wave activity index, smoothed zonal differences, and recording of hypersynchronous alpha waves or three-phase waves, which were determined already in the early stages of the disease. Comparing the psychometric testing data and the neuroimaging results, it was noted that the identified cognitive disorders, including those at the latent stage of hepatic encephalopathy, were accompanied by the frontal and parietal lobes cortex hypotrophy and the subcortical structures damage. Progression of the hepatic encephalopathy was accompanied by increased cognitive, emotional, motor and sleep disorders, which was confirmed by the results of psychometric testing, and also coincided with the functional and morphological disorders worsening of the brain according to the neurophysiological and neuroimaging examinations.