scholarly journals Altered Modular Organization of Functional Connectivity Networks in Cirrhotic Patients without Overt Hepatic Encephalopathy

2014 ◽  
Vol 2014 ◽  
pp. 1-11 ◽  
Author(s):  
Gang Zheng ◽  
Liping Zhang ◽  
Long Jiang Zhang ◽  
Qiang Li ◽  
Zhiying Pan ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Functional Connectivity ◽  
Neuropsychological Test ◽  
Minimal Hepatic Encephalopathy ◽  
Ammonia Level ◽  
Modular Organization ◽  
Healthy Controls ◽  
Overt Hepatic Encephalopathy ◽  
Cirrhotic Patients ◽  
Subcortical Regions

Minimal hepatic encephalopathy (MHE) is associated with changes in functional connectivity. To investigate the patterns of modular changes of the functional connectivity in the progression of MHE, resting-state functional magnetic resonance imaging was acquired in 24 MHE patients, 31 cirrhotic patients without minimal hepatic encephalopathy (non-HE), and 38 healthy controls. Newman’s metric, the modularityQvalue, was maximized and compared in three groups. Topological roles with the progression of MHE were illustrated by intra- and intermodular connectivity changes. Results showed that theQvalue of MHE patients was significantly lower than that of controlsP<0.01rather than that of non-HE patientsP>0.05, which was correlated with neuropsychological test scores rather than the ammonia level and Child-Pugh score. Less intrasubcortical connections and more isolated subcortical modules were found with the progression of MHE. The non-HE patients had the same numbers of connect nodes as controls and had more hubs compared with MHE patients and healthy controls. Our findings supported that both intra- and intermodular connectivity, especially those related to subcortical regions, were continuously impaired in cirrhotic patients. The adjustments of hubs and connector nodes in non-HE patients could be a compensation for the decreased modularity in their functional connectivity networks.

Hippocampal atrophy and functional connectivity disruption in cirrhotic patients with minimal hepatic encephalopathy

2019 ◽  
Vol 34 (6) ◽  
pp. 1519-1529 ◽  
Author(s):  
Weiwen Lin ◽  
Xuhui Chen ◽  
Yong-Qing Gao ◽  
Zhe-Ting Yang ◽  
Weizhu Yang ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Functional Connectivity ◽  
Minimal Hepatic Encephalopathy ◽  
Hippocampal Atrophy ◽  
Cirrhotic Patients

scholarly journals Whole-brain functional connectivity neuromarkers uncover the cognitive recovery scheme for overt hepatic encephalopathy after liver transplantation

2020 ◽  
Author(s):  
Yue Cheng ◽  
Wen Shen ◽  
Junhai Xu ◽  
Rachel C. Amey ◽  
Li-Xiang Huang ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Hepatic Encephalopathy ◽  
Functional Connectivity ◽  
Resting State ◽  
Resting State Fmri ◽  
Neurocognitive Performance ◽  
Resting State Functional Connectivity ◽  
Psychomotor Tests ◽  
Overt Hepatic Encephalopathy ◽  
Cirrhotic Patients

AbstractNeurocognitive impairment is present in cirrhosis and may be more severe in cirrhosis with the overt hepatic encephalopathy (OHE). Liver transplantation (LT) may reverse the impaired brain function. MRI of resting-state functional connectivity can help unravel the underlying mechanisms that lead to these cognitive deficits and recovery. Sixty-four cirrhotic patients (28 with OHE; 36 without) and 32 healthy controls were recruited for resting-state fMRI. The patients were scanned before and after LT. We evaluated pre- and postsurgical neurocognitive performance in cirrhotic patients using psychomotor tests, i.e. number connection test (NCT) and digit symbol test (DST). Network-based statistics found significant disrupted connectivity in both groups of cirrhosis with OHE and without compared to controls. However, the presurgical connectivity disruption in patients with OHE was included in a greater number of connections than those without (65 vs. 17). The decrease in FC for both OHE and non-OHE patient groups was reversed to the level of controls after LT. An additional hyperconnected network (i.e., higher than controls) was observed in OHE patients after LT (p=0.009). Regarding the neural-behavior relationship, the functional network that predicted cognitive performance in healthy individuals, showed no correlation in presurgical cirrhotic patients. Such an impaired neural-behavior relationship was re-established after LT for non-OHE patients but not for OHE. OHE patients displayed abnormal hyperconnectivity and persistently impaired neural-behavior relationship after LT. Our results suggest that patients with OHE may undergo a different trajectory of postsurgical neurofunctional recovery in comparison to those without, which needs further clarification in the future study.

scholarly journals Reestablishing Brain Networks in Patients without Overt Hepatic Encephalopathy after Liver Transplantation

2014 ◽  
Vol 34 (12) ◽  
pp. 1877-1886 ◽  
Author(s):  
Wei-Che Lin ◽  
Tun-Wei Hsu ◽  
Chao-Long Chen ◽  
Cheng-Hsien Lu ◽  
Hsiu-Ling Chen ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Hepatic Encephalopathy ◽  
Large Scale ◽  
Brain Networks ◽  
Functional Networks ◽  
Healthy Controls ◽  
Overt Hepatic Encephalopathy ◽  
Cirrhotic Patients ◽  
Information Processing Deficits ◽  
Large Scale Networks

Cirrhotic patients without overt hepatic encephalopathy (HE) have associated with widespread neuro-psychological impairment. Liver transplantation can restore metabolic abnormalities but the mechanisms are unclear. We investigate brain functional networks after transplantation using resting-state funtional magnetic resonance imaging (MRI). Twenty-six cirrhotic patients without overt HE completed neuro-psychological assessment before and 6 to 12 months after transplantation, and compared with 35 healthy controls. Five major functional brain networks, default mode (DMN), dorsal attention (DAN), executive control (ECN), salience (SN), and primary networks (PN), were assessed. Nodal efficiency and strength in different functional networks were weighed and their interaction metrics displayed. Granger causal analysis between pretransplantation and posttransplantation was performed. Before transplantation, the intrafunctional connectivity was decreased in DMN, DAN, ECN, and SN. After transplantation, cognitive functions improved with increased functional connectivity. The interaction metrics among large-scale networks in patients became similar to healthy controls. The increase in PN affected the decrease in SN, while the increase in DAN forced a decrease in DMN. There was a bidirectional balance between DMN and SN. Dynamic disruptions and reconstruction in intrinsic large-scale networks are associated with parallel patterns of cognitive information processing deficits and recovery. Remapping of SN, DMN, and DAN is essential for restoring cognition after transplantation.

scholarly journals Factors associated with non-response to lactulose therapy in cirrhotic patients with minimal hepatic encephalopathy

2018 ◽  
Vol 12 (1) ◽  
pp. 15-21
Author(s):  
Shireen Ahmed ◽  
Md Golam Azam ◽  
Indrajit Kumar Datta ◽  
Md Nazmul Hoque ◽  
Tareq M Bhuiyan
Keyword(s):  
Hepatic Encephalopathy ◽  
Arterial Pressure ◽  
Minimal Hepatic Encephalopathy ◽  
Ammonia Level ◽  
Response To Treatment ◽  
Psychometric Tests ◽  
Cirrhotic Patients ◽  
Serum Ammonia Level ◽  
The Mean ◽  
Serum Ammonia

Background and objectives: Minimal hepatic encephalopathy (MHE) impairs health related quality of life and predicts overt hepatic encephalopathy (HE) in cirrhotic patients. Lactulose is effective in the treatment of MHE. But the response to lactulose treatment depends on several factors. This study was aimed to find out the contributing factors to non-response to lactulose therapy.Materials and methods: The study was carried out at the BIRDEM general hospital from September, 2013 to March, 2015. Sixty patients were enrolled to assess the response of lactulose therapy in cirrhotic patients with MHE. MHE was diagnosed based on abnormal psychometric tests namely, number connection test (NCT), digit symbol test (DST) and high serum ammonia level. A daily dose of 30-60 ml of lactulose was given to all patients for one month. The response to treatment with regard to MHE was determined after one month using defined criteria. The response was graded as responder and non-responder.Results: The mean age of the study population was 57.0±10.3 years. Out of 60 cases, 46 (77%) were male and 39 (65%) had diabetes. Out of 60 enrolled MHE cases, 16 (27%) had Child-Turcotte-Pugh-A (CTP-A) score and 44 (73%) belonged to CTP-B & C category. Out of 60 MHE cases, 23 (38.3%) showed improvement in their MHE status based on normalization of psychometric tests and reduction of serum ammonia level to ≤32 μmol/L. Age, gender and diabetes were not associated with the response to lactulose therapy. Low baseline arterial pressure was significantly (p=0.003) associated with non-response to lactulose treatment. The mean baseline ammonia level was higher significantly among the nonresponders compared to the responders (83.6±21.4 μmol/L vs 58.8±19.8 μmol/L, p<0.001). Compared to responders, low serum sodium and potassium and raised serum bilirubin levels of non-responders at baseline were found significantly (p<0.05) associated with non-response to one month of lactulose treatment. Initial hemoglobulin, peripheral leucocyte and platelet counts did not have any effect on the response to lactulose treatment in MHE cases.Conclusions: The status of MHE in patients with cirrhosis improved by one-month treatment with lactulose. Baseline low arterial pressure, hyperammonemia, hypokalemia and hyponatremia were major contributors to non-response to lactulose therapy. The findings of the study would be useful in treating patients of cirrhosis with MHE.IMC J Med Sci 2018; 12(1): 15-21

scholarly journals Thalamic Structural Connectivity Abnormalities in Minimal Hepatic Encephalopathy

2021 ◽  
Vol 15 ◽  
Author(s):  
Hua-Jun Chen ◽  
Xiao-Hong Zhang ◽  
Jia-Yan Shi ◽  
Shao-Fan Jiang ◽  
Yi-Fan Sun ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
White Matter ◽  
Diffusion Tensor ◽  
Structural Connectivity ◽  
Mean Diffusivity ◽  
Minimal Hepatic Encephalopathy ◽  
Probabilistic Tractography ◽  
Neurocognitive Performance ◽  
Cirrhotic Patients ◽  
Subcortical Regions

Background and Aims: Numerous studies have demonstrated thalamus-related structural, functional, and metabolic abnormalities in minimal hepatic encephalopathy (MHE). We conducted the first study to investigate thalamic structural connectivity alterations in MHE.MethodsDiffusion tensor imaging (DTI)-based probabilistic tractography was employed to determine the structural linkage between the thalamus and cortical/subcortical regions in 52 cirrhotic patients [22 with MHE; 30 without MHE (NHE)] and 30 controls. We measured these thalamic connections, which included connectivity strength (CS), fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD), and then compared these among the three groups. Neurocognitive assessment was also performed. Correlation analysis was conducted to investigate the relationship between neurocognitive performance and the above measurements. Classification analysis was performed to determine whether thalamic connection measurements can distinguish MHE from NHE.ResultsThe probabilistic tractography revealed thalamic structural connections, which were disrupted in cirrhotic patients (as reflected by a decrease in CS/FA and an increase in MD/AD/RD). Abnormal thalamic connections primarily involved the prefrontal cortex, sensorimotor cortex, parietal cortex, medial temporal cortex and hippocampus, and striatum. Thalamic connectivity abnormalities deteriorated from NHE to MHE, and they were correlated with patients’ neurocognitive performance. The moderate classification accuracy was obtained using CS and MD as discriminating indexes.ConclusionOur results demonstrated the altered thalamic structural connectivity involving both cortical and subcortical regions in MHE, which could be regarded as representative of MHE-related widespread impairments in white matter pathways. The disturbed thalamic connectivity may underlie the mechanism of cognitive deficits in MHE and may potentially be utilized as a biomarker for diagnosing MHE and in monitoring disease progression. In addition to thalamic–cortical/subcortical connections, further studies are recommended to explore the structural alterations in other white matter pathways in MHE.

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