Subject: Hepatitis C and cognitive impairment in a cohort of patients with
Author:
Forton, D et al (HEPATOLOGY 2002;35:433-439)
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Date Posted:Sun, August 11 2002, 5:12:17 PDT In reply to:
H. Aaron Aronow,MD Neurology and Internal Medicine USC ..
's message, "Neurological manifestation of HCV" on Sat, May 19 2001, 10:27:06 PDT
Hepatitis C and cognitive impairment in a cohort of patients with
mild liver disease
Abstract
Patients with chronic hepatitis C virus (HCV) infection frequently
report fatigue, lassitude, depression, and a perceived inability to
function effectively. Several studies have shown that patients
exhibit low
quality-of-life scores that are independent of disease severity. We
therefore considered whether HCV infection has a direct effect on the
central
nervous system, resulting in cognitive and cerebral metabolite
abnormalities. Twenty-seven viremic patients with biopsy-proven mild
hepatitis
due to HCV and 16 patients with cleared HCV were tested with a
computer-based cognitive assessment battery and also completed
depression,
fatigue, and quality-of-life questionnaires. The HCV-infected
patients were
impaired on more cognitive tasks than the HCV-cleared group (mean
[SD]:
HCV-infected, 2.15 [1.56]; HCV-cleared, 1.06 [1.24]; P = .02). A
factor
analysis showed impairments in power of concentration and speed of
working memory, independent of a history of intravenous drug usage
(IVDU),
depression, fatigue, or symptom severity. A subgroup of 17
HCV-infected
patients also underwent cerebral proton magnetic resonance
spectroscopy
(1H MRS). The choline/creatine ratio was elevated in the basal
ganglia
and white matter in this group. Patients who were impaired on 2 or
more
tasks in the battery had a higher mean choline/creatine ratio
compared
with the unimpaired patients. In conclusion, these preliminary
results
demonstrate cognitive impairment that is unaccounted for by
depression,
fatigue, or a history of IVDU in patients with histologically mild
HCV
infection. The findings on MRS suggest that a biological cause
underlies this abnormality. (HEPATOLOGY 2002;35:433-439.)
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