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Neurocognitive and Muscular Capacities Are Associated with Frailty in Adults with Cirrhosis

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Abstract

Background

Frailty is common in cirrhosis and associated with mortality, hospitalization, and reduced quality of life. Interventions aimed at forestalling frailty are limited by a lack of understanding of underlying physiologic deficits.

Aims

This study’s aim was to examine contributions of discrete sensorimotor and neurocognitive capacities to conventional frailty measures of unipedal stance time, chair stands, and grip strength.

Methods

This cross-sectional study enrolled 119 outpatients with cirrhosis (50% female, aged 62.9 ± 7.3 years). Capacities included sensory (lower limb sensation and visual contrast), neurocognitive (Number Connection Tests A and B, simple and recognition reaction time), and muscular (hip/core strength determined by lateral plank time (LPT)). Bivariate analyses and linear regression models were performed to identify significant contributors to each frailty measure.

Results

The average performance was 9.8 ± 3.9 chair stands, 12.7 s ±9.9 unipedal stance time, and 60.3 ± 25.6 lb grip strength. In multivariate models, factors explained 40% of variance in unipedal stance and 43% of variance in chair stands. The LPT was most strongly associated with unipedal stance and chair stands. Grip strength was associated with LPT, but did not have physiologic predictors.

Conclusions

Clinically useful measures of frailty in adults with cirrhosis can be explained by disease severity but also deficits in strength and neurocognitive function. Recognition reaction time, a novel measure in cirrhosis, had a significant contribution to frailty. These findings have implications for frailty assessment and suggest that the optimal rehabilitation approach to frailty targets neurocognitive function in addition to strengthening.

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Funding

This project was supported in part by the Newman Family Foundation awarded to Dr. Richardson. Dr. Tapper receives funding from the National Institutes of Health through the Michigan Institute for Clinical and Health Research (KL2TR002241). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, University of Michigan, 24 Frank Lloyd Wright Drive, Lobby M, Suite 3100, Ann Arbor, MI, 48105, USA

    Susan L. Murphy, James K. Richardson & Beanna Martinez

  2. Research Health Science Specialist, VA Ann Arbor Healthcare System, GRECC, Ann Arbor, USA

    Susan L. Murphy

  3. Physical Therapy Department, University of Michigan-Flint, Flint, USA

    Jennifer Blackwood

  4. Department of Internal Medicine, University of Michigan, Ann Arbor, USA

    Elliot B. Tapper

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  1. Susan L. Murphy
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Correspondence to Susan L. Murphy.

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Conflicts of interest

Co-authors Tapper and Murphy are disclosing the following relationships. Tapper serves as a consultant for Novartis, is on the advisory board for Mallinckrodt and for Baush, and receives grant support from Valeant and Gilead. Murphy receives grant support from Lymphatouch Inc. No author has relevant conflicts of interest to disclose.

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Murphy, S.L., Richardson, J.K., Blackwood, J. et al. Neurocognitive and Muscular Capacities Are Associated with Frailty in Adults with Cirrhosis. Dig Dis Sci 65, 3734–3743 (2020). https://doi.org/10.1007/s10620-020-06099-4

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