Digestive Diseases and Sciences

, Volume 25, Issue 10, pp 763–768

Prevalence of subclinical hepatic encephalopathy in cirrhotics and relationship to plasma amino acid imbalance

  • Giulio Marchesini
  • Marco Zoli
  • Cristina Dondi
  • Lucia Cecchini
  • Angela Angiolini
  • Francesco B. Bianchi
  • Emilio Pisi
Original Articles


Neuropsychological status, as assessed by trailmaking test; plasma amino acids, and ammonia, were studied in 54 cirrhotics without clinical evidence of encephalopathy to determine the prevalence of subclinical mental dysfunction and its relationship to metabolic abnormalities. Control values for psychometric performance were established in 54 normal subjects matched for age, sex, educational level, and employment status. Of these subjects, 16 were also used as controls for fasting ammonia and plasma amino acids. Eighteen cirrhotics (33%) showed impaired performances of the psychometric test; free tryptophan and the ratio free tryptophan to neutral amino acids were increased in 37% and 62% of cases and correlated with the psychometric scores (r=0.45 andr=0.70, respectively). In eight cirrhotics with mild encephalopathy, psychometric and metabolic evaluations were repeated several times during the infusion of amino acid solutions rich in branched-chain amino acids. Again significant correlations were observed between the psychometric scores and plasma amino acids. We conclude that a considerable proportion of clinically normal cirrhotics have neuropsychological deficits. The severity of impairment may be related to the plasma amino acid imbalance, namely to an increased passage of tryptophan across the blood-brain barrier.


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Copyright information

© Digestive Disease Systems, Inc. 1980

Authors and Affiliations

  • Giulio Marchesini
    • 1
  • Marco Zoli
    • 1
  • Cristina Dondi
    • 1
  • Lucia Cecchini
    • 1
  • Angela Angiolini
    • 1
  • Francesco B. Bianchi
    • 1
  • Emilio Pisi
    • 1
  1. 1.Istituto di Patologia Medica 1University of BolognaBolognaItaly

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