1. Altered postural control and stability in cirrhotic patients with minimal hepatic encephalopathy correlate with cognitive deficits.
- Author
-
Urios A, Mangas-Losada A, Gimenez-Garzó C, González-López O, Giner-Durán R, Serra MA, Noe E, Felipo V, and Montoliu C
- Subjects
- Ammonia blood, Attention, Case-Control Studies, Chi-Square Distribution, Cognition Disorders diagnosis, Cognition Disorders physiopathology, Cognition Disorders psychology, Female, Hepatic Encephalopathy diagnosis, Hepatic Encephalopathy physiopathology, Hepatic Encephalopathy psychology, Humans, Interleukins blood, Liver Cirrhosis diagnosis, Liver Cirrhosis physiopathology, Liver Cirrhosis psychology, Logistic Models, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Physical Examination, Predictive Value of Tests, Psychometrics, Psychomotor Performance, Risk Factors, Sensation Disorders diagnosis, Sensation Disorders physiopathology, Sensation Disorders psychology, Stroop Test, Accidental Falls, Cognition, Cognition Disorders etiology, Hepatic Encephalopathy etiology, Liver Cirrhosis complications, Postural Balance, Sensation Disorders etiology
- Abstract
Background & Aims: Cognitive dysfunction in cirrhotic patients with minimal hepatic encephalopathy (MHE) is associated with falls. Alterations in postural control and stability could contribute to increase falls risk in these patients. We aimed to assess whether postural control and direction-specific limits of stability are altered in cirrhotic patients with MHE compared to patients without MHE and controls. We also assessed if alterations in postural control correlate with neurological impairment and/or blood biomarkers., Methods: Posturography analysis, attention Stroop test and bimanual and visuo-motor coordination tests were performed in 18 controls, 19 patients with cirrhosis without MHE and 17 with MHE, diagnosed by PHES. Posturography was assessed by NedSVE
® /IBV system under four sensory conditions. Limits of stability and rhythmic weight-shifting tests were also performed. Blood ammonia and serum interleukins were also measured. Falls were assessed after 12-24 months follow-up., Results: MHE patients show impaired balance, mainly on unstable surface with eyes open, with longer reaction and confinement times and lower success in Limits of Stability test compared to patients without MHE. Performance in attention and motor coordination tests correlated with most posturography parameters alterations. Logistic regression analysis shows that posturography parameters and bimanual coordination test are good predictors of falls., Conclusion: Balance patterns and limits of stability in MHE patients are impaired compared to patients without MHE and controls. This seems to contribute to a higher falls risk. Attention and motor coordination deficits could contribute to balance impairment in patients with MHE., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)- Published
- 2017
- Full Text
- View/download PDF