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Sarcopenia and cognitive impairment in liver cirrhosis: A viewpoint on the clinical impact of minimal hepatic encephalopathy

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World Journal of Gastroenterology 2019年第35期25卷 5257-5265页

作者： Silvia Nardelli Stefania Gioia jessica faccioli Oliviero Riggio Lorenzo Ridola Department of Translational and Precision Medicine "Sapienza" University of Rome

Minimal hepatic encephalopathy (MHE) represents the mildest type of hepatic encephalopathy (HE). MHE is considered as a preclinical stage of HE and is part of a wide spectrum of typical neurocognitive alterations characteristic of patients with liver cirrhosis, particularly involving the areas of attention, alertness, response inhibition, and executive functions. MHE can be detected by testing the patients’ psychometric performance, attention, working memory, psychomotor speed, and visuospatial ability, as well as by means of electrophysiological and other functional brain measures. MHE is very frequent, affecting from 20% up to 80% of patients tested, depending of the diagnostic tools used. Although subclinical, MHE is considered to be clinically relevant. In fact, MHE has been related to the patients’ falls, fitness to drive, and working ability. As a consequence, MHE affects the patients and caregivers lives by altering their quality of life and even their socioeconomic status. Recently sarcopenia, a very common condition in patients with advanced liver disease, has been shown to be strictly related to both minimal and overt HE. Aim of this review is to summarize the most recently published evidences about the emerging relationship between sarcopenia and cognitive impairment in cirrhotic patients and provide suggestions for future research.

关键词： Minimal hepatic encephalopathy Cognitive impairment Sarcopenia Muscle alterations Cirrhosis

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Neurological and psychiatric effects of hepatitis C virus infection

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World Journal of Gastroenterology 2021年第29期27卷 4846-4861页

作者： jessica faccioli Silvia Nardelli Stefania Gioia Oliviero Riggio Lorenzo Ridola Department of Translational and Precision Medicine “Sapienza”University of RomeRome 00185Italy

Hepatitis C virus(HCV)infection is widespread and affects 71 million people *** hepatic manifestations are the most frequent,ranging from chronic hepatitis to cirrhosis and hepatocellular carcinoma,it is also associated with several extrahepatic *** patients may present nonspecific neurological symptoms,regardless of the presence of liver *** pathogenetic mechanisms underlying neurological symptoms have been hypothesized:neuroinvasion,immune-mediated damage,neurotransmitter alterations and *** of the central nervous system include cerebral vasculopathy,acute or subacute encephalopathy and inflammatory *** infection may be responsible for neuropathies,of which the most frequent form is symmetrical axonal sensory or sensory-motor polyneuropathy which causes loss of leg sensitivity and *** to 50%of patients with HCV infection may experience cognitive decline and psychological disorders,such as depression and *** associated neurocognitive disorder is independent of the presence of liver cirrhosis and affects different domains than in patients with hepatic *** can be studied using specific tests that mainly explore executive functions,verbal learning and verbal *** disorders significantly reduce the quality of *** new antiviral therapies improve the extrahepatic symptoms of HCV infection and their success depends on the achievement of sustained virological ***,the effect of therapy may differ depending on the type of organ involved;neurological symptoms can be irreversible if there is organic liver *** aim of this review is to provide a critical overview of physiopathological mechanisms,diagnostic and therapeutic strategies of the neurological and psychiatric effects of HCV infection.

关键词： Hepatitis C virus Neurological disorders Psychiatric disorders Antiviral therapy Quality of life Hepatic encephalopathy

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Determinants of prognosis in cirrhosis:a new outlook

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Hepatobiliary Surgery and Nutrition 2022年第5期11卷 759-761页

作者： Lorenzo Ridola Stefania Gioia jessica faccioli Silvia Nardelli Oliviero Riggio Department of Translational and Precision Medicine “Sapienza”University of RomeRomeItaly

The metanalysis by Tantai and collaborators highlights the role of sarcopenia in cirrhosis by demonstrating that the presence of muscular alterations is independently related with a mortality(HR 2.61)(1).Sarcopenia is confirmed as a condition with high prevalence in patients with cirrhosis(37.5%),being more representative in males than females(41.9%vs.37.8%)and in subjects with alcoholic etiology(49.6%)or with more advanced degree of liver disease(Child Pugh C 46.7%).Interestingly,authors demonstrate that sarcopenia was associated with mortality in subjects with MELD15(HR 2.34)as well evaluating only on studies that excluded patients with hepatocellular carcinoma(HCC),risk of mortality was similar to that of the main analysis(2.35)(1).

关键词： cirrhosis mortality alterations

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