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

• Published in: Metabolic brain disease Vol. 27; no. 1; pp. 51 - 58
• Main Authors: Felipo, Vicente, Urios, Amparo, Montesinos, Encarna, Molina, Inmaculada, Garcia-Torres, Maria L., Civera, Miguel, Del Olmo, Juan A., Ortega, Joaquin, Martinez-Valls, Jose, Serra, Miguel A., Cassinello, Norberto, Wassel, Abdallah, Jordá, Esperanza, Montoliu, Carmina
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01-03-2012; Springer Nature B.V
• Subjects: Adult; Aged; Ammonia; Ammonia - blood; Biochemistry; Biomedical and Life Sciences; Biomedicine; Blood; Cirrhosis; Cognitive ability; Cognitive Dysfunction - etiology; Cognitive Dysfunction - metabolism; Data processing; Fatty liver; Fatty Liver - blood; Fatty Liver - metabolism; Female; Hepatic encephalopathy; Hepatic Encephalopathy - blood; Hepatic Encephalopathy - complications; Hepatic Encephalopathy - metabolism; Humans; hyperammonemia; Hyperammonemia - complications; Hyperammonemia - metabolism; Inflammation; Inflammation - complications; Inflammation - metabolism; Interleukin 18; Interleukin 6; Interleukin-18 - blood; Interleukin-6 - blood; Keloid - blood; Keloid - complications; Keloid - metabolism; Liver Cirrhosis - blood; Liver Cirrhosis - complications; Liver Cirrhosis - metabolism; Liver diseases; Male; Metabolic Diseases; Metabolic disorders; Middle Aged; Neurology; Neuropsychological Tests; Neurosciences; Non-alcoholic Fatty Liver Disease; Oncology; Original Paper; Psoriasis; Psoriasis - blood; Psoriasis - complications; Psoriasis - metabolism; Severity of Illness Index; Minimal hepatic encephalopathy; Keloids; Inflammation; Non-alcoholic steatohepatitis; Hyperammonemia; Liver disease
• ISSN: 0885-7490; 1573-7365
• DOI: 10.1007/s11011-011-9269-3

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.