ABSTRACT
RESUMO INTRODUÇÃO: A encefalopatia hepática mínima (EHM) tem sido associada a alterações na capacidade de condução de veículos, ao aparecimento da forma explícita de encefalopatia hepática e a um pior prognóstico. Contudo, o seu real impacto na qualidade de vida (QV) permanece controverso. Com o desenvolvimento das normas de aplicação e cotação da Pontuação Psicométrica da Encefalopatia Hepática (PPEH) para diagnóstico da EHM para a população portuguesa, este estudo tem como objetivo determinar o efeito desta perturbação neurocognitiva na QV dos pacientes. MÉTODOS: A amostra é composta por dois grupos: Grupo Controle (GC; n = 8) e Grupo Cirrose Hepática (GCH; n = 8). Dos oito pacientes pertencentes ao GCH, quatro revelaram presença de EHM, diagnosticada de acordo com os critérios da PPEH. A QV foi avaliada através do Medical Outcomes Study, Short Form-36 (SF-36). RESULTADOS: Em comparação com o GC, o GCH apresentou pontuações significativamente mais baixas em todos os domínios do SF-36, com exceção da sub-dimensão dor física. Quando se compara os pacientes com e sem EH não se observam diferenças significativas em nenhum dos domínios do SF-36. CONCLUSÕES: Os pacientes com cirrose hepática apresentam uma pior QV em relação aos indivíduos saudáveis; a EHM não afeta a QV. Estudos com maior número de pacientes são necessários para confirmação destes achados
INTRODUCTION: Minimal hepatic encephalopathy (MHE) has been associated with changes in the ability to drive, with the onset of the explicit form of hepatic encephalopathy and with a worse prognosis. However, the impact of MHE on quality of life (QoL) remains controversial. With the standardization of the Psychometric Hepatic Encephalopathy Score (PHES) for the diagnosis of MHE in the Portuguese population, this study aimed to determine the effect of this neurocognitive disorder on the patients' QoL. METHODS: The sample consisted of two groups: the control group (CG, n = 8) and the liver cirrhosis group (LCG, n = 8). Of the eight patients in the LCG, four presented with MHE, diagnosed according to PHES criteria. QoL was assessed using the Medical Outcomes Study, Short Form 36 (SF-36). RESULTS: Compared with the CG, the LCG had significantly lower scores in all domains of the SF-36, except for the physical pain subdomain. When patients with and without HE were compared, no significant differences were found in any of the SF-36 domains. CONCLUSIONS: Patients with liver cirrhosis have a worse QoL when compared with healthy controls; EHM does not affect QoL. Further studies with a higher number of patients are required to confirm these findings
Subject(s)
Humans , Male , Adult , Quality of Life/psychology , Hepatic Encephalopathy/psychology , Liver Cirrhosis/complications , Psychomotor Performance , Activities of Daily Living/psychology , Hepatic Encephalopathy/etiology , Neuropsychological TestsABSTRACT
Objective: To investigate the links between depression and cognitive functioning in patients with Hepatitis C and other chronic liver diseases with and without the use of alcohol on the waiting list for liver transplantation and their associations with the MELD classification. Method: 40 patients were evaluated on a waiting list for liver transplant by a battery of neuropsychological tests, depression scales and interview at the Liver Transplant Service, of the Hospital das Clínicas University of São Paulo Medical School. Results: After splitting the sample according to the education, the results showed statistical significance in the comparisons between groups of MELD > 15 and <15 in the following functions: estimated IQ, visual-spatial delayed recall and recognition as part of episodic memory and short term memory. Conclusion: These findings, usually found in hepatic encephalopathy, corroborated with the literature and emphasized the need to investigate in more detail the cognitive functions of these patients in order to facilitate the adoption of different conducts.
Objetivo: Investigar as relações entre depressão e funcionamento cognitivo em pacientes portadores de hepatite C e demais doenças hepáticas crônicas com e sem uso de álcool em fila de espera para transplante hepático e suas relações com a classificação MELD. Método: Foram avaliados 40 pacientes em lista de espera para transplante hepático por bateria de testes neuropsicológicos, escalas de depressão e entrevista no Serviço de Transplante do Fígado do HC-FMUSP. Resultados: Após divisão da amostra por escolaridade os resultados mostraram significância estatística nas comparações entre grupos de MELD > 15 e <15 nas funções: QI estimado, memória episódica de evocação tardia e de reconhecimento visuo-espacial e memória de curto prazo. Conclusão: As dificuldades encontradas, comuns ao quadro de encefalopatia hepática, corroboram a literatura pesquisada e enfatizam a necessidade de se investigar de maneira mais detalhada o funcionamento cognitivo destes pacientes, uma vez que diferentes condutas podem ser adotadas.
Subject(s)
Female , Humans , Male , Affect , Cognition Disorders/etiology , Depression/psychology , Hepatic Encephalopathy/etiology , Liver Cirrhosis/complications , Liver Transplantation/psychology , Chronic Disease , Cross-Sectional Studies , Cognition Disorders/diagnosis , Educational Status , Hepatic Encephalopathy/diagnosis , Hepatic Encephalopathy/psychology , Liver Cirrhosis/surgery , Neuropsychological Tests , Patient Selection , Prospective Studies , Severity of Illness Index , Waiting ListsABSTRACT
The serious neuropsychological repercussions of hepatic encephalopathy have led to the creation of several experimental models in order to better understand the pathogenesis of the disease. In the present investigation, two possible causes of hepatic encephalopathy, cholestasis and portal hypertension, were chosen to study the behavioral impairments caused by the disease using an object recognition task. This working memory test is based on a paradigm of spontaneous delayed non-matching to sample and was performed 60 days after surgery. Male Wistar rats (225-250 g) were divided into three groups: two experimental groups, microsurgical cholestasis (N = 20) and extrahepatic portal hypertension (N = 20), and a control group (N = 20). A mild alteration of the recognition memory occurred in rats with cholestasis compared to control rats and portal hypertensive rats. The latter group showed the poorest performance on the basis of the behavioral indexes tested. In particular, only the control group spent significantly more time exploring novel objects compared to familiar ones (P < 0.001). In addition, the portal hypertension group spent the shortest time exploring both the novel and familiar objects (P < 0.001). These results suggest that the existence of portosystemic collateral circulation per se may be responsible for subclinical encephalopathy.