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Working Memory in Patients with Varying Degree of Hepatic Encephalopathy (HE): A Pilot EEG-fNIRS Study

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Abstract

It is known that patients with covert hepatic encephalopathy (CHE) exhibit working memory abnormalities, but to date there is no study comparing patients with cirrhosis with/without CHE and controls with both electrophysiological and hemodynamic data collected at the same time.

Here we collected behavioral [accuracy and reaction times (RTs), electrophysiological (evoked potentials) and hemodynamic (oxygenated and deoxygenated haemoglobin) correlates of an n-back task [formed by a control (0-back) condition, a low (1-back) and a high (2-back) working memory load conditions] in patients with cirrhosis with/without CHE: (1) at baseline (n = 21, males = 15, 58±8 yrs), and by comparison with controls (n = 21, males = 15, 57±11 yrs) and (2) after a 3-month course of rifaximin (n = 18, males = 12, 61±11 yrs), and by comparison to baseline.

All patients showed slower RTs (p < 0.0001) and lower P2 amplitude compared with controls (p = 0.018); moreover, patients with CHE showed reduced accuracy (p < 0.0001) compared with controls, and patients without CHE showed higher oxygenated haemoglobin in the central dorsolateral prefrontal cortex in the 2-back compared with patients with CHE. Post-rifaximin, oxygenated haemoglobin increased in the central frontopolar cortex. In addition, in patients without CHE the RTs of the 2-back became comparable to those of the 0-back and P3 showed higher amplitude.

In conclusion, the presence of cirrhosis seemed to have more effects than CHE on working memory at baseline. A course of treatment with rifaximin was more beneficial to patients without CHE, who probably had more room for improvement in this complex task.

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Data Availability

The datasets generated during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Medicine, University of Padova, Via Giustiniani 2, Padova, 35128, Italy

    Lisa Zarantonello, Chiara Mangini, Davide Erminelli, Silvano Fasolato, Paolo Angeli, Piero Amodio & Sara Montagnese

  2. Chronobiology Section, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK

    Sara Montagnese

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Contributions

LZ, PAm and SM conceived and designed the study. CM, SF and PAn recruited the patients. LZ acquired the data. LZ, CM, DE, PAm, and SM analysed/interpreted the data. LZ and SM drafted the manuscript. SF and PAn reviewed the manuscript for important intellectual content. All authors have read and approved the final version of the manuscript.

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Correspondence to Lisa Zarantonello.

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Zarantonello, L., Mangini, C., Erminelli, D. et al. Working Memory in Patients with Varying Degree of Hepatic Encephalopathy (HE): A Pilot EEG-fNIRS Study. Neurochem Res (2023). https://doi.org/10.1007/s11064-023-04034-3

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