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Open Access 01-08-2020 | Hepatic Encephalopathy | Review Article

Cognition-tracking-based strategies for diagnosis and treatment of minimal hepatic encephalopathy

Authors: Weijia Han, Huanqian Zhang, Ying Han, Zhongping Duan

Published in: Metabolic Brain Disease | Issue 6/2020

Abstract

Minimal hepatic encephalopathy (MHE), which shows mild cognitive impairment, is a subtle complication of cirrhosis that has been shown to affect daily functioning and quality of life. However, until 2014, relevant guidelines do not give much attention to the diagnosis and treatment of MHE, resulting in patients being ignored and denied the benefits of treatment. In this review, we summarize recent cognition-based research about (1) alteration of nerve cells, including astrocytes, microglial cells and neurons, in mild cognitive impairment in MHE; (2) comparison of methods in detecting cognitive impairment in MHE; and (3) comparison of methods for therapy of cognitive impairment in MHE. We hope to provide information about diagnosis and treatment of cognitive impairment in patients with MHE.

Agusti A, Cauli O, Rodrigo R, Llansola M, Hernandez-Rabaza V, Felipo V (2011) p38 MAP kinase is a therapeutic target for hepatic encephalopathy in rats with portacaval shunts. Gut 60:1572–1579PubMed

Alvares-da-Silva MR, de Araujo A, Vicenzi JR, da Silva GV, Oliveira FB, Schacher F, Oliboni L, Magnus A, Kruel LP, Prieb R, Fernandes LN (2014) Oral l-ornithine-l-aspartate in minimal hepatic encephalopathy: a randomized, double-blind, placebo-controlled trial. Hepatol Res 44:956–963PubMed

Arias N, Mendez M, Gomez-Lazaro E, Azpiroz A, Arias JL (2015) Main target of minimal hepatic encephalopathy: Morphophysiological, inflammatory and metabolic view. Physiol Behav 149:247–254PubMed

Badea MA, Drug VL, Dranga M, Gavrilescu O, Stefanescu G, Popa I, Mihai C, Cijevschi-Prelipcean C (2016) Diagnosis of minimal hepatic encephalopathy in a tertiary care center from eastern Romania: validation of the psychometric hepatic encephalopathy score (PHES). Metab Brain Dis 31:1463–1471PubMed

Bajaj JS (2008) Minimal hepatic encephalopathy matters in daily life. World J Gastroenterol 14:3609–3615PubMedPubMedCentral

Bajaj JS, Fagan A, White MB, Wade JB, Hylemon PB, Heuman DM, Fuchs M, John BV, Acharya C, Sikaroodi M, Gillevet PM (2019) Specific gut and salivary microbiota patterns are linked with different cognitive testing strategies in minimal hepatic encephalopathy. Am J Gastroenterol 114:1080–1090PubMedPubMedCentral

Bajaj JS, Heuman DM, Wade JB, Gibson DP, Saeian K, Wegelin JA, Hafeezullah M, Bell DE, Sterling RK, Stravitz RT, Fuchs M, Luketic V, Sanyal AJ (2011) Rifaximin improves driving simulator performance in a randomized trial of patients with minimal hepatic encephalopathy. Gastroenterology 140(478–487):e471

Bajaj JS, Saeian K, Christensen KM, Hafeezullah M, Varma RR, Franco J, Pleuss JA, Krakower G, Hoffmann RG, Binion DG (2008) Probiotic yogurt for the treatment of minimal hepatic encephalopathy. Am J Gastroenterol 103:1707–1715PubMed

Bajaj JS, Thacker LR, Heuman DM, Fuchs M, Sterling RK, Sanyal AJ, Puri P, Siddiqui MS, Stravitz RT, Bouneva I, Luketic V, Noble N, White MB, Monteith P, Unser A, &Wade JB (2013) The Stroop smartphone application is a short and valid method to screen for minimal hepatic encephalopathy. Hepatology 58: 1122–1132

Balzano T, Dadsetan S, Forteza J, Cabrera-Pastor A, Taoro-Gonzalez L, Malaguarnera M, Gil-Perotin S, Cubas-Nunez L, Casanova B, Castro-Quintas A, Ponce-Mora A, Arenas YM, Leone P, Llansola M, Felipo V (2019) Chronic hyperammonemia induces peripheral inflammation that leads to cognitive impairment in rats: reversal by anti-tnfa treatment. J Hepatol

Barone M, Shahini E, Iannone A, Viggiani MT, Corvace V, Principi M, Di Leo A (2018) Critical flicker frequency test predicts overt hepatic encephalopathy and survival in patients with liver cirrhosis. Dig Liver Dis 50:496–500PubMed

Butterworth RF, McPhail MJW (2019) L-ornithine L-aspartate (LOLA) for hepatic encephalopathy in cirrhosis: results of randomized controlled trials and meta-analyses. Drugs 79:31–37PubMedPubMedCentral

Buyeverov AO, Bogomolov PO, Mayev IV, Matsievich MV, Uvarova OV (2019) Possibilities of therapeutic correction of hyperammonemia and minimal hepatic encephalopathy in patients with chronic hepatitis C at the pre-cirrhotic stage. Terapevticheskii Arkhiv 91:52–58PubMed

Cabrera-Pastor A, Hernandez-Rabaza V, Taoro-Gonzalez L, Balzano T, Llansola M, Felipo V (2016) In vivo administration of extracellular cGMP normalizes TNF-alpha and membrane expression of AMPA receptors in hippocampus and spatial reference memory but not IL-1beta, NMDA receptors in membrane and working memory in hyperammonemic rats. Brain Behav Immun 57:360–370PubMed

Cabrera-Pastor A, Llansola M, Montoliu C, Malaguarnera M, Balzano T, Taoro-Gonzalez L, Garcia-Garcia R, Mangas-Losada A, Izquierdo-Altarejos P, Arenas YM, Leone P, Felipo V (2019) Peripheral inflammation induces neuroinflammation that alters neurotransmission and cognitive and motor function in hepatic encephalopathy: underlying mechanisms and therapeutic implications. Acta Physiol (Oxf) 226:e13270

Campagna F, Montagnese S, Ridola L, Senzolo M, Schiff S, De Rui M, Pasquale C, Nardelli S, Pentassuglio I, Merkel C, Angeli P, Riggio O, Amodio P (2017) The animal naming test: an easy tool for the assessment of hepatic encephalopathy. Hepatology 66:198–208PubMed

Cao Q, Yu CB, Yang SG, Cao HC, Chen P, Deng M, Li LJ (2018) Effect of probiotic treatment on cirrhotic patients with minimal hepatic encephalopathy: a meta-analysis. Hepatobiliary & Pancreatic Diseases International 17:9–16

Chen HJ, Chen R, Yang M, Teng GJ, Herskovits EH (2015) Identification of minimal hepatic encephalopathy in patients with cirrhosis based on white matter imaging and Bayesian data mining. AJNR Am J Neuroradiol 36:481–487PubMed

Chen HJ, Zhang L, Jiang LF, Chen QF, Li J, Shi HB (2016) Identifying minimal hepatic encephalopathy in cirrhotic patients by measuring spontaneous brain activity. Metab Brain Dis 31:761–769PubMed

Chen MF, Li RC, Chen CH, Gao XC (2005) [Therapeutic effect of L-ornithine-L-aspartate on liver cirrhosis complicated by hepatic encephalopathy]. Di 1 Jun Yi Da Xue Xue Bao. Academic Journal of the First Medical College of Pla 25:718–719 722PubMed

Chepkova AN, Sergeeva OA, Gorg B, Haas HL, Klocker N, Haussinger D (2017) Impaired novelty acquisition and synaptic plasticity in congenital hyperammonemia caused by hepatic glutamine synthetase deficiency. Sci Rep 7:40190PubMedPubMedCentral

Coskun B, Ozen M, Gursoy S, Ozbakir O, Poyrazoglu OK, Baskol M, Sezgin GC, Yucesoy M (2017) Normalization of the psychometric hepatic encephalopathy score for diagnosis of minimal hepatic encephalopathy in Turkey. Niger J Clin Pract 20:421–426PubMed

Di Lemma LCG, Field M (2017) Cue avoidance training and inhibitory control training for the reduction of alcohol consumption: a comparison of effectiveness and investigation of their mechanisms of action. Psychopharmacology 234:2489–2498PubMedPubMedCentral

Ding S, Wang W, Wang X, Liang Y, Liu L, Ye Y, Yang J, Gao H, Zhuge Q (2016) Dopamine burden triggers Neurodegeneration via production and release of TNF-alpha from astrocytes in minimal hepatic encephalopathy. Mol Neurobiol 53:5324–5343PubMed

Ding S, Wang X, Zhuge W, Yang J, Zhuge Q (2017a) Dopamine induces glutamate accumulation in astrocytes to disrupt neuronal function leading to pathogenesis of minimal hepatic encephalopathy. Neuroscience 365:94–113PubMed

Ding S, Xu Z, Yang J, Liu L, Huang X, Wang X, Zhuge Q (2017b) The involvement of the decrease of Astrocytic Wnt5a in the cognitive decline in minimal hepatic encephalopathy. Mol Neurobiol 54:7949–7963PubMed

Ding S, Yang J, Liu L, Ye Y, Wang X, Hu J, Chen B, Zhuge Q (2014) Elevated dopamine induces minimal hepatic encephalopathy by activation of astrocytic NADPH oxidase and astrocytic protein tyrosine nitration. International Journal of Biochemistry & Cell Biology 55:252–263

Ding S, Zhuge W, Yang J, Wen F, Xu Z, Wang X, Zhuge Q (2018) Insulin resistance disrupts the interaction between AKT and the NMDA receptor and the inactivation of the CaMKIV/CREB pathway in minimal hepatic encephalopathy. Toxicol Sci 161:208PubMed

Dossi E, Vasile F, Rouach N (2018) Human astrocytes in the diseased brain. Brain Res Bull 136:139–156PubMedPubMedCentral

El-Karaksy HM, Afifi O, Bakry A, Kader AA, Saber N (2017) A pilot study using lactulose in management of minimal hepatic encephalopathy in children with extrahepatic portal vein obstruction. World J Pediatr 13:70–75PubMed

Felipo V, Urios A, Montesinos E, Molina I, Garcia-Torres ML, Civera M, Olmo JA, Ortega J, Martinez-Valls J, Serra MA, Cassinello N, Wassel A, Jorda E, Montoliu C (2012) Contribution of hyperammonemia and inflammatory factors to cognitive impairment in minimal hepatic encephalopathy. Metab Brain Dis 27:51–58PubMed

Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT (2002) Hepatic encephalopathy--definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th world congresses of gastroenterology, Vienna, 1998. Hepatology 35:716–721PubMed

Fumagalli M, Lombardi M, Gressens P, Verderio C (2018) How to reprogram microglia toward beneficial functions. Glia 66:2531–2549PubMedPubMedCentral

Gimenez-Garzo C, Garces JJ, Urios A, Mangas-Losada A, Garcia-Garcia R, Gonzalez-Lopez O, Giner-Duran R, Escudero-Garcia D, Serra MA, Soria E, Felipo V, Montoliu C (2017) The PHES battery does not detect all cirrhotic patients with early neurological deficits, which are different in different patients. PLoS One 12:e0171211PubMedPubMedCentral

Goel A, Rahim U, Nguyen LH, Stave C, Nguyen MH (2017) Systematic review with meta-analysis: rifaximin for the prophylaxis of spontaneous bacterial peritonitis. Aliment Pharmacol Ther 46:1029–1036PubMed

Goh ET, Stokes CS, Sidhu SS, Vilstrup H, Gluud LL, Morgan MY (2018) L-ornithine L-aspartate for prevention and treatment of hepatic encephalopathy in people with cirrhosis. Cochrane Database Syst Rev 5:CD012410PubMed

Greinert R, Ripoll C, Hollenbach M, Zipprich A (2016) Stepwise diagnosis in covert hepatic encephalopathy: critical flicker frequency and MELD-score as a first-step approach. Aliment Pharmacol Ther 44:514–521PubMed

Gupta D, Ingle M, Shah K, Phadke A, Sawant P (2015) Prospective comparative study of inhibitory control test and psychometric hepatic encephalopathy score for diagnosis and prognosis of minimal hepatic encephalopathy in cirrhotic patients in the Indian subcontinent. J Dig Dis 16:400–407PubMed

Hammerman C, Bin-Nun A, Kaplan M (2006) Safety of probiotics: comparison of two popular strains. BMJ 333:1006–1008PubMedPubMedCentral

Hartmann L, Wachtl L, de Lucia M, Spierer L (2019) Practice-induced functional plasticity in inhibitory control interacts with aging. Brain Cogn 132:22–32PubMed

Hernandez-Rabaza V, Agusti A, Cabrera-Pastor A, Fustero S, Delgado O, Taoro-Gonzalez L, Montoliu C, Llansola M, Felipo V (2015) Sildenafil reduces neuroinflammation and restores spatial learning in rats with hepatic encephalopathy: underlying mechanisms. J Neuroinflammation 12:195PubMedPubMedCentral

Hernandez-Rabaza V, Cabrera-Pastor A, Taoro-Gonzalez L, Malaguarnera M, Agusti A, Llansola M, Felipo V (2016) Hyperammonemia induces glial activation, neuroinflammation and alters neurotransmitter receptors in hippocampus, impairing spatial learning: reversal by sulforaphane. J Neuroinflammation 13:41PubMedPubMedCentral

Hudson M, Schuchmann M (2019) Long-term management of hepatic encephalopathy with lactulose and/or rifaximin: a review of the evidence. Eur J Gastroenterol Hepatol 31:434–450PubMed

Jackson JG, Robinson MB (2018) Regulation of mitochondrial dynamics in astrocytes: mechanisms, consequences, and unknowns. Glia 66:1213–1234PubMed

Janssen N, Hernandez-Cabrera JA, Foronda LE (2018) Improving the signal detection accuracy of functional magnetic resonance imaging. Neuroimage 176:92–109PubMed

Jiang SM, Jia L, Zhang MH (2015) Probiotic and lactulose: influence on gastrointestinal flora and pH value in minimal hepatic encephalopathy rats. Int J Clin Exp Med 8:9996–10000PubMedPubMedCentral

Jiao Y, Wang XH, Chen R, Tang TY, Zhu XQ, Teng GJ (2017) Predictive models of minimal hepatic encephalopathy for cirrhotic patients based on large-scale brain intrinsic connectivity networks. Sci Rep 7:11512PubMedPubMedCentral

Kale RA, Gupta RK, Saraswat VA, Hasan KM, Trivedi R, Mishra AM, Ranjan P, Pandey CM, Narayana PA (2006) Demonstration of interstitial cerebral edema with diffusion tensor MR imaging in type C hepatic encephalopathy. Hepatology 43:698–706PubMed

Kircheis G, Luth S (2019) Pharmacokinetic and Pharmacodynamic properties of L-ornithine L-aspartate (LOLA) in hepatic encephalopathy. Drugs 79:23–29PubMedPubMedCentral

Kooka Y, Sawara K, Endo R, Kato A, Suzuki K, Takikawa Y (2016) Brain metabolism in minimal hepatic encephalopathy assessed by 3.0-tesla magnetic resonance spectroscopy. Hepatol Res 46:269–276PubMed

Krabbe KS, Reichenberg A, Yirmiya R, Smed A, Pedersen BK, Bruunsgaard H (2005) Low-dose endotoxemia and human neuropsychological functions. Brain Behav Immun 19:453–460PubMed

Kulkarni VV, Maday S (2018) Compartment-specific dynamics and functions of autophagy in neurons. Developmental Neurobiology 78:298–310PubMed

Labenz C, Beul L, Toenges G, Schattenberg JM, Nagel M, Sprinzl MF, Nguyen-Tat M, Zimmermann T, Huber Y, Marquardt JU, Galle PR, Worns MA (2019) Validation of the simplified animal naming test as primary screening tool for the diagnosis of covert hepatic encephalopathy. European Journal of Internal Medicine 60:96–100PubMed

Li JL, Jiang H, Zhang XD, Huang LX, Xie SS, Zhang L, Cheng Y, Shen W (2019) Microstructural brain abnormalities correlate with neurocognitive dysfunction in minimal hepatic encephalopathy: a diffusion kurtosis imaging study. Neuroradiology 61:685–694PubMed

Li W, Li N, Wang R, Li Q, Wu H (2015) Interferon gamma, interleukin-6, and -17a levels were correlated with minimal hepatic encephalopathy in HBV patients. Hepatol Int 9:218–223PubMed

Llansola M, Montoliu C, Agusti A, Hernandez-Rabaza V, Cabrera-Pastor A, Gomez-Gimenez B, Malaguarnera M, Dadsetan S, Belghiti M, Garcia-Garcia R, Balzano T, Taoro L, Felipo V (2015) Interplay between glutamatergic and GABAergic neurotransmission alterations in cognitive and motor impairment in minimal hepatic encephalopathy. Neurochem Int 88:15–19PubMed

Lockwood AH, Yap EW, Wong WH (1991) Cerebral ammonia metabolism in patients with severe liver disease and minimal hepatic encephalopathy. J Cereb Blood Flow Metab 11:337–341PubMed

Luo M, Li L, Lu CZ, Cao WK (2011) Clinical efficacy and safety of lactulose for minimal hepatic encephalopathy: a meta-analysis. Eur J Gastroenterol Hepatol 23:1250–1257PubMed

Luo M, Ma P, Li L, Cao WK (2019) Advances in psychometric tests for screening minimal hepatic encephalopathy: from paper-and-pencil to computer-aided assessment. Turk J Gastroenterol 30:398–407PubMedPubMedCentral

Lyon KC, Likar E, Martello JL, Regier M (2017) Retrospective cross-sectional pilot study of rifaximin dosing for the prevention of recurrent hepatic encephalopathy. J Gastroenterol Hepatol 32:1548–1552PubMed

Malaguarnera M, Llansola M, Balzano T, Gomez-Gimenez B, Antunez-Munoz C, Martinez-Alarcon N, Mahdinia R, Felipo V (2019) Bicuculline reduces neuroinflammation in hippocampus and improves spatial learning and anxiety in hyperammonemic rats. Role of glutamate receptors. Front Pharmacol 10:132PubMedPubMedCentral

McPhail MJ, Bajaj JS, Thomas HC, Taylor-Robinson SD (2010) Pathogenesis and diagnosis of hepatic encephalopathy. Expert Rev Gastroenterol Hepatol 4:365–378PubMed

Metwally MA, Biomy HA, Omar MZ, Sakr AI (2019) Critical flickering frequency test: a diagnostic tool for minimal hepatic encephalopathy. Eur J Gastroenterol Hepatol 31:1030–1034PubMed

Morgan MY, Amodio P, Cook NA, Jackson CD, Kircheis G, Lauridsen MM, Montagnese S, Schiff S, Weissenborn K (2016) Qualifying and quantifying minimal hepatic encephalopathy. Metab Brain Dis 31:1217–1229PubMed

Nardelli S, Lattanzi B, Merli M, Farcomeni A, Gioia S, Ridola L, Riggio O (2019) Muscle alterations are associated with minimal and overt hepatic encephalopathy in patients with liver cirrhosis. Hepatology

Nardone R, Taylor AC, Holler Y, Brigo F, Lochner P, Trinka E (2016) Minimal hepatic encephalopathy: a review. Neurosci Res 111:1–12PubMed

Olesen SS, Gram M, Jackson CD, Halliday E, Sandberg TH, Drewes AM, Morgan MY (2016) Electroencephalogram variability in patients with cirrhosis associates with the presence and severity of hepatic encephalopathy. J Hepatol 65:517–523PubMed

Ozel Coskun BD, Ozen M (2017) Critical flicker frequency test for diagnosing minimal hepatic encephalopathy in patients with cirrhosis. Turk J Gastroenterol 28:191–196PubMed

Qi R, Zhang LJ, Luo S, Ke J, Kong X, Xu Q, Liu C, Lu H, Lu GM (2014) Default mode network functional connectivity: a promising biomarker for diagnosing minimal hepatic encephalopathy: CONSORT-compliant article. Medicine (Baltimore) 93:e227

Ridola L, Nardelli S, Gioia S, Riggio O (2018) Quality of life in patients with minimal hepatic encephalopathy. World J Gastroenterol 24:5446–5453PubMedPubMedCentral

Rovira A, Grive E, Pedraza S, Rovira A, Alonso J (2001) Magnetization transfer ratio values and proton MR spectroscopy of normal-appearing cerebral white matter in patients with liver cirrhosis. AJNR Am J Neuroradiol 22:1137–1142PubMed

Ruszkowski J, Witkowski JM (2019) Lactulose: patient- and dose-dependent prebiotic properties in humans. Anaerobe 59:100–106PubMed

Saji S, Kumar S, Thomas V (2011) A randomized double blind placebo controlled trial of probiotics in minimal hepatic encephalopathy. Trop Gastroenterol 32:128–132PubMed

Sanchez E, Casafont F, Guerra A, de Benito I, Pons-Romero F (2005) Role of intestinal bacterial overgrowth and intestinal motility in bacterial translocation in experimental cirrhosis. Rev Esp Enferm Dig 97:805–814PubMed

Sanders ME, Akkermans LM, Haller D, Hammerman C, Heimbach J, Hormannsperger G, Huys G, Levy DD, Lutgendorff F, Mack D, Phothirath P, Solano-Aguilar G, Vaughan E (2010) Safety assessment of probiotics for human use. Gut Microbes 1:164–185PubMedPubMedCentral

Sato T, Endo K, Kakisaka K, Suzuki Y, Kooka Y, Sawara K, Ito K, Sasaki M, Takikawa Y (2019) Decreased mean kurtosis in the putamen is a diagnostic feature of minimal hepatic encephalopathy in patients with cirrhosis. Intern Med 58:1217–1224PubMedPubMedCentral

Schulz C, Schutte K, Vilchez-Vargas R, Vasapolli R, Malfertheiner P (2019) Long-term effect of Rifaximin with and without lactulose on the active bacterial assemblages in the proximal small bowel and Faeces in patients with minimal hepatic encephalopathy. Dig Dis 37:161–169PubMed

Schumann C (2002) Medical, nutritional and technological properties of lactulose. An update European Journal of Nutrition 41(Suppl 1):I17–I25PubMed

Seo K, Jun DW, Kim JK, Ryu H (2017) Multi-sensory integration impairment in patients with minimal hepatic encephalopathy. Sci Rep 7:14947PubMedPubMedCentral

Sharma P, Sharma BC, Sarin SK (2010) Predictors of nonresponse to lactulose in patients with cirrhosis and hepatic encephalopathy. Eur J Gastroenterol Hepatol 22:526–531PubMed

Shavakhi A, Hashemi H, Tabesh E, Derakhshan Z, Farzamnia S, Meshkinfar S, Shavakhi S, Minakari M, Gholamrezaei A (2014) Multistrain probiotic and lactulose in the treatment of minimal hepatic encephalopathy. Journal of Research in Medical Sciences 19:703–708PubMedPubMedCentral

Shawcross DL, Wright G, Olde Damink SW, Jalan R (2007) Role of ammonia and inflammation in minimal hepatic encephalopathy. Metab Brain Dis 22:125–138PubMed

Sidhu SS, Goyal O, Parker RA, Kishore H, Sood A (2016) Rifaximin vs. lactulose in treatment of minimal hepatic encephalopathy. Liver Int 36:378–385PubMed

Singh J, Sharma BC, Maharshi S, Puri V, Srivastava S (2016) Spectral electroencephalogram in liver cirrhosis with minimal hepatic encephalopathy before and after lactulose therapy. J Gastroenterol Hepatol 31:1203–1209PubMed

Singh J, Sharma BC, Puri V, Sachdeva S, Srivastava S (2017) Sleep disturbances in patients of liver cirrhosis with minimal hepatic encephalopathy before and after lactulose therapy. Metab Brain Dis 32:595–605PubMed

Srivastava A, Yadav SK, Yachha SK, Thomas MA, Saraswat VA, Gupta RK (2011) Pro-inflammatory cytokines are raised in extrahepatic portal venous obstruction, with minimal hepatic encephalopathy. J Gastroenterol Hepatol 26:979–986PubMed

Stewart CA, Smith GE (2007) Minimal hepatic encephalopathy. Nature Clinical Practice: Gastroenterology & Hepatology 4:677–685

Stinton LM, Jayakumar S (2013) Minimal hepatic encephalopathy. Can J Gastroenterol 27:572–574PubMedPubMedCentral

Stravitz RT, Gottfried M, Durkalski V, Fontana RJ, Hanje AJ, Koch D, Hameed B, Ganger D, Subramanian RM, Bukofzer S, Ravis WR, Clasen K, Sherker A, Little L, Lee WM, Acute Liver Failure Study G (2018) Safety, tolerability, and pharmacokinetics of l-ornithine phenylacetate in patients with acute liver injury/failure and hyperammonemia. Hepatology 67:1003–1013PubMedPubMedCentral

Suraweera D, Sundaram V, Saab S (2016) Evaluation and Management of Hepatic Encephalopathy: current status and future directions. Gut Liver 10:509–519PubMedPubMedCentral

Tapper EB, Parikh ND, Waljee AK, Volk M, Carlozzi NE, Lok AS (2018) Diagnosis of minimal hepatic encephalopathy: a systematic review of point-of-care diagnostic tests. Am J Gastroenterol 113:529–538PubMed

Tsai CF, Chu CJ, Huang YH, Wang YP, Liu PY, Lin HC, Lee FY, Lu CL (2015) Detecting minimal hepatic encephalopathy in an endemic country for hepatitis B: the role of psychometrics and serum IL-6. PLoS One 10:e0128437PubMedPubMedCentral

Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, Weissenborn K, Wong P (2014) Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the liver. Hepatology 60:715–735PubMed

Wang J, Li R, Guo C, Fournier C, W KW (2008) The influence of fractionation on cell survival and premature differentiation after carbon ion irradiation. J Radiat Res 49:391–398PubMed

Wang Y, Shi XJ, Abuduheilili X, Fan XT, Ma HL, Feng J, Sun J, A LY, He FP (2013) Critical flicker frequency for the diagnosis of minimal hepatic encephalopathy. Zhonghua Gan Zang Bing Za Zhi 21:546–547PubMed

Wuensch T, Ruether DF, Zollner C, Mueller T, Jung T, Kaffarnik M, Kassner U, Schott E, Kiefer S, Pratschke J, Stockmann M, Jara M (2017) Performance characterization of a novel electronic number connection test to detect minimal hepatic encephalopathy in cirrhotic patients. Eur J Gastroenterol Hepatol 29:456–463PubMed

Wunsch E, Koziarska D, Milkiewicz M, Naprawa G, Nowacki P, Hartleb M, Milkiewicz P (2013) In patients with liver cirrhosis, proinflammatory interleukins correlate with health-related quality of life irrespective of minimal hepatic encephalopathy. Eur J Gastroenterol Hepatol 25:1402–1407PubMed

Xia X, Chen J, Xia J, Wang B, Liu H, Yang L, Wang Y, Ling Z (2018) Role of probiotics in the treatment of minimal hepatic encephalopathy in patients with HBV-induced liver cirrhosis. J Int Med Res 46:3596–3604PubMedPubMedCentral

Yoon EL, Jun DW, Jeong JY, Kim TY, Song DS, Ahn SB, Kim HY, Jung YK, Song MJ, Kim SE, Kim HS, Jeong SW, Kim SG, Lee TH, Cho YK, Kim JK, Ryu H (2019) Validation of the Korean Stroop test in diagnosis of minimal hepatic encephalopathy. Sci Rep 9:8027PubMedPubMedCentral

Zeng X, Li XX, Shi PM, Zhang YY, Song Y, Liu Q, Wei L, Bajaj JS, Zhu YH, Li Y, Gu Y, Xie WF, Liu YL (2019) Utility of the EncephalApp Stroop test for covert hepatic encephalopathy screening in Chinese cirrhotic patients. J Gastroenterol Hepatol

Zhang XD, Zhang LJ, Wu SY, Lu GM (2014) Multimodality magnetic resonance imaging in hepatic encephalopathy: an update. World J Gastroenterol 20:11262–11272PubMedPubMedCentral

Zhong WJ, Zhou ZM, Zhao JN, Wu W, Guo DJ (2016) Abnormal spontaneous brain activity in minimal hepatic encephalopathy: resting-state fMRI study. Diagn Interv Radiol 22:196–200PubMedPubMedCentral

Zhuge W, Wen F, Ni Z, Zheng Z, Zhu X, Lin J, Wang J, Zhuge Q, Ding S (2019) Dopamine burden triggers cholesterol overload following disruption of synaptogenesis in minimal hepatic encephalopathy. Neuroscience 410:1–15PubMed

Zuo Z, Fan H, Tang XD, Chen YM, Xun LT, Li Y, Song ZJ, Zhai HQ (2017) Effect of different treatments and alcohol addiction on gut microbiota in minimal hepatic encephalopathy patients. Exp Therap Med 14:4887–4895

Title: Cognition-tracking-based strategies for diagnosis and treatment of minimal hepatic encephalopathy
Authors: Weijia Han
Huanqian Zhang
Ying Han
Zhongping Duan
Publication date: 01-08-2020
Publisher: Springer US
Keywords: Hepatic Encephalopathy
Probiotics
Rifaximin
Hepatic Encephalopathy
Published in: Metabolic Brain Disease / Issue 6/2020
Print ISSN: 0885-7490
Electronic ISSN: 1573-7365
DOI: https://doi.org/10.1007/s11011-020-00539-w

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Cognition-tracking-based strategies for diagnosis and treatment of minimal hepatic encephalopathy

Abstract

At a glance: The ONWARDS insulin icodec trials

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Abstract

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