Nonalcoholic cirrhosis associated with neuropsychological dysfunction in the absence of overt evidence of hepatic encephalopathy

Abstract

Although much is known about the neuropsychological functioning of cirrhotic individuals with Laennec's (alcohol associated) cirrhosis, little is known about the neuropsychological functioning of individuals with nonalcoholic cirrhosis. In the present investigation, we have determined that individuals suffering from chronic nonalcoholic cirrhosis, despite the absence of clinical signs of hepatic encephalopathy, are impaired on neuropsychological tests that measure visuopractic capacity, visual scanning, and perceptual-motor speed. In contrast, intellectual, language, memory, attentional, motor, and learning abilities are intact. In comparison with a chronically ill control group of patients suffering from Crohn's disease, individuals with advanced nonalcoholic cirrhosis exhibit less emotional disturbance, but are more impaired in their daily activities. These findings indicate that individuals with nonalcoholic cirrhosis, even in the absence of overt clinical signs of encephalopathy, manifest neuropsychological impairments and experience significant disruption in the routines of everyday living.

Figure 1

Profiles of the nonalcoholic cirrhosis patients and the Crohn's disease subjects on the Minnesota Multiphasic Personality Inventory (MMPI). The population norm is 50, and a score >70 is pathognomonic.

Figure 2

Profiles of the nonalcoholic cirrhosis patients and the Crohn's disease subjects on the 16 Personality Factors Questionnaire (16PF). The population norm is 5, from which a plus or minus 2 SD is considered implicative of the respective personality trait.

Figure 3

Profiles of the nonalcoholic cirrhosis patients and the Crohn's disease subjects on the Sickness Impact Profile (SIP). The higher the score, the greater the adverse impact of the illness on daily functioning.