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Metabolic Brain Disease

, Volume 27, Issue 1, pp 51–58 | Cite as

Contribution of hyperammonemia and inflammatory factors to cognitive impairment in minimal hepatic encephalopathy

  • Vicente Felipo
  • Amparo Urios
  • Encarna Montesinos
  • Inmaculada Molina
  • Maria L. Garcia-Torres
  • Miguel Civera
  • Juan A. Del Olmo
  • Joaquin Ortega
  • Jose Martinez-Valls
  • Miguel A. Serra
  • Norberto Cassinello
  • Abdallah Wassel
  • Esperanza Jordá
  • Carmina MontoliuEmail author
Original Paper

Abstract

To assess the contribution of hyperammonemia and inflammation to induction of mild cognitive impairment (or MHE). We analyzed the presence of mild cognitive impairment (CI) by using the PHES battery of psychometric tests and measured the levels of ammonia and of the inflammatory cytokines IL-6 and IL-18 in blood of patients with different types of liver or dermatological diseases resulting in different grades of hyperammonemia and/or inflammation. The study included patients with 1) liver cirrhosis, showing hyperammonemia and inflammation; 2) non-alcoholic fatty liver disease (NAFLD) showing inflammation but not hyperammonemia; 3) non-alcoholic steatohepatitis (NASH) showing inflammation and very mild hyperammonemia; 4) psoriasis, showing inflammation but not hyperammonemia; 5) keloids, showing both inflammation and hyperammonemia and 6) controls without inflammation or hyperammonemia. The data reported show that in patients with liver diseases, cognitive impairment may appear before progression to cirrhosis if hyperammonemia and inflammation are high enough. Five out of 11 patients with NASH, without liver cirrhosis, showed cognitive impairment associated with hyperammonemia and inflammation. Patients with keloids showed cognitive impairment associated with hyperammonemia and inflammation, in the absence of liver disease. Hyperammonemia or inflammation alone did not induce CI but the combination of certain levels of hyperammonemia and inflammation is enough to induce CI, even without liver disease.

Keywords

Minimal hepatic encephalopathy Hyperammonemia Inflammation Keloids Liver disease Non-alcoholic steatohepatitis 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Vicente Felipo
    • 1
  • Amparo Urios
    • 2
  • Encarna Montesinos
    • 3
  • Inmaculada Molina
    • 3
  • Maria L. Garcia-Torres
    • 4
  • Miguel Civera
    • 5
  • Juan A. Del Olmo
    • 4
  • Joaquin Ortega
    • 6
  • Jose Martinez-Valls
    • 5
  • Miguel A. Serra
    • 4
  • Norberto Cassinello
    • 6
  • Abdallah Wassel
    • 4
  • Esperanza Jordá
    • 3
  • Carmina Montoliu
    • 2
    Email author
  1. 1.Laboratory of Neurobiology. Centro de Investigación Príncipe FelipeValenciaSpain
  2. 2.Fundación Investigación Hospital Clínico Universitario de Valencia. INCLIVAValenciaSpain
  3. 3.Servicio de Dermatología, Hospital Clínico UniversitarioValenciaSpain
  4. 4.Grupo Hepatología. Servicio Aparato Digestivo. Hospital Clínico UniversitarioValenciaSpain
  5. 5.Servicio de Endrocrinologia, Hospital Clínico UniversitarioValenciaSpain
  6. 6.Servicio de Cirugía, Hospital Clínico UniversitarioValenciaSpain

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