Abstract
Many cirrhotics have abnormal neuropsychological test scores. To define the anatomical–physiological basis for encephalopathy in nonalcoholic cirrhotics, we performed resting-state fluorodeoxyglucose positron emission tomographic scans and administered a neuropsychological test battery to 18 patients and 10 controls. Statistical parametric mapping correlated changes in regional glucose metabolism with performance on the individual tests and a composite battery score. In patients without overt encephalopathy, poor performance correlated with reductions in metabolism in the anterior cingulate. In all patients, poor performance on the battery was positively correlated (p < 0.001) with glucose metabolism in bifrontal and biparietal regions of the cerebral cortex and negatively correlated with metabolism in hippocampal, lingual, and fusiform gyri and the posterior putamen. Similar patterns of abnormal metabolism were found when comparing the patients to 10 controls. Metabolic abnormalities in the anterior attention system and association cortices mediating executive and integrative function form the pathophysiological basis for mild hepatic encephalopathy.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
REFERENCES
Frackowiak, R.S.J., Friston, K.J., Frith, C.D., Dolan, R.J., and Mazziotta, J.C. (1997). Human Brain Function, Academic Press, New York.
Gilberstadt, S.J., Gilberstadt, H., Zieve, L., Beugel, B., Collier, R.O., Jr., and McClain, C.J. (1980). Psychomotor performance defects in cirrhotic patients without overt encephalopathy. Arch. Int. Med. 140:519-521.
Gitlin, N., Lewis, D.C., and Hinkley, L. (1986). The diagnosis and prevalence of subclinical hepatic encephalopathy in apparently healthy, ambulant, non-shunted patients with cirrhosis. J. Hepatol. 3:75-82.
Groeneweg, M., Moerland, W., Quero, J.C., Hop, W.C., Krabbe, P.F., and Schalm, S.W. (2000). Screening of subclinical hepatic encephalopathy. J. Hepatol. 32:748-753.
Holm, E., Thiele, H., Wolpert, E.M., Heim, M.E., and Reimann-Werle, B. (1980). Neurologische und Psychiatrische Symptome bei akuten und chronischen Leberkrankheiten. Therapiewoche 30:4790-4806.
Huang, S.-C., Phelps, M.E., Hoffman, E.J., Sideris, K., Selin, C.J., and Kuhl, D.E. (1980). Noninvasive determination of local cerebral metabolic rate of glucose in man. Am. J. Physiol. 238:E69-E82.
Lockwood, A.H. (1992). Hepatic Encephalopathy, Butterworth Heinemann, Stoneham, Massachusetts.
Lockwood, A.H., Murphy, B.W., Donnelly, K.Z., Mahl, T.C., and Perini, S. (1993). Positron-emission tomographic localization of abnormalities of brain metabolism in patients with minimal hepatic encephalopathy. Hepatology 18:1061-1068.
Lockwood, A.H., Weissenborn, K., Burchert,W., Bokemeyer, M., and Wack, D.S. (1998). Neuropsychological test deficits correlate with altered cerebral glucose metabolism in patients with non-alcoholic cirrhosis. Neurology 50:A253.
Lockwood, A.H., Weissenborn, K., and Butterworth, R.F. (1997). An image of the brain in patients with liver disease. Curr. Opinion Neurobiol. 10:525-533.
Lockwood, A.H., Yap, E.W.H., Rhoades, H.M., and Wong,W.-H. (1991). Altered cerebral blood flow and glucose metabolism in patients with liver disease and minimal encephalopathy. J. Cereb. Blood Flow Metab. 11:331-336.
Martin, A.J., Friston, K.J., Colebatch, J.G., and Frackowiak, R.S.J. (1991). Decreases in regional cerebral blood flow with normal aging. J. Cereb. Blood Flow Metab. 11:684-689.
Parsons-Smith, B.G., Summerskill, W.H.J., Dawson, A.M., and Sherlock, S. (1957). The electroencephalogram in liver disease. Lancet ii:867-871.
Patlak, C.S., Blasberg, R.G., and Fenstermacher, J.D. (1983). Graphical evaluation of blood-to-brain transfer constants from multiple-time uptake data. J. Cereb. Blood Flow Metab. 3:1-7.
Posner, M.I. (1995). Attention in cognitive neuroscience: An overview. In (M.S. Gazzaniga, ed.), The Cognitive Neurosciences, MIT Press, Cambridge Massachusetts, pp. 615-624.
Posner, M.I. and Driver, J. (1992). The neurobiology of selective attention. Curr. Opionion Neurobiol. 2:165-169.
Posner, M.I. and Petersen, S.E. (1990). The attention system of the human brain. Annu. Rev. Neurosci. 13:25-42.
Rikkers, L., Jenko, P., Rudman, D., and Freides, D. (1978). Subclinical hepatic encephalopathy: Detection, prevalence, and relationship to nitrogen metabolism. Gastroenterology 75:462-469.
Schomerus, H. and Schreiegg, J. (1993). Prevalence of latent portasystemic encephalopathy in an unselected population of patients with liver cirrhosis in general practice. Zeitschrift fur Gastroenterologie 31:231-234.
Schomerus, H., Weissenborn, K., Hecker, H., Hamster,W., and Rückert, N. (1999). PSE Syndrom Test: Psychodiagnostisches Verfahren zur quantitativen Erfassung der (minimalen) portosystemischen Encephalopathie (PSE), Swets Test Services, Frankfurt.
Schultz, S.K., O'Leary, D.S., Boles Ponto, L.L., Watkins, G.L., Hichwa, R.D., and Andreasen, N.C. (1999). Agerelated changes in regional cerebral blood flow among young to mid-life adults. NeuroReport 10:2493-2496.
Shima, K. and Tanji, J. (1998). Role for cingulate motor area cells in voluntary movement selection based on reward. Science 282:1335-1338.
Talairach, J. and Tournoux, P. (1988). Co-Planar Stereotaxic Atlas of the Human Brain, Georg Thieme Verlag, Stuttgart and New York.
Tarter, R.E., Hegedus, A.M., Van Thiel, D.H., Schade, R.R., Gavaler, J.S., and Starzl, T.E. (1984). Nonalcoholic cirrhosis associated with neuropsychological dysfunction in the absence of overt evidence of hepatic encephalopathy. Gastroenterology 86:1421-1427.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lockwood, A.H., Weissenborn, K., Bokemeyer, M. et al. Correlations Between Cerebral Glucose Metabolism and Neuropsychological Test Performance in Nonalcoholic Cirrhotics. Metab Brain Dis 17, 29–40 (2002). https://doi.org/10.1023/A:1014000313824
Issue Date:
DOI: https://doi.org/10.1023/A:1014000313824