Journal
METABOLIC BRAIN DISEASE
Volume 27, Issue 1, Pages 51-58Publisher
SPRINGER/PLENUM PUBLISHERS
DOI: 10.1007/s11011-011-9269-3
Keywords
Minimal hepatic encephalopathy; Hyperammonemia; Inflammation; Keloids; Liver disease; Non-alcoholic steatohepatitis
Categories
Funding
- Ministerio de Ciencia e Innovacion [SAF2008-00062, CSD2008-00005, FIS 06/0065, PS09/00806]
- Conselleria de Educacion [ACOMP/2009/191, ACOMP-2009-025, PROMETEO/2009/027]
- Conselleria de Sanitat, Generalitat Valenciana [AP-079/08, AP-092/09, AP-028/10, AP-087/11]
- Fundacion Investigacion Medica Mutua Madrilena
- Fundacion MAPFRE
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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 with-out 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.
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