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World J Gastroenterol. Sep 21, 2019; 25(35): 5257-5265
Published online Sep 21, 2019. doi: 10.3748/wjg.v25.i35.5257
Sarcopenia and cognitive impairment in liver cirrhosis: A viewpoint on the clinical impact of minimal hepatic encephalopathy
Silvia Nardelli, Stefania Gioia, Jessica Faccioli, Oliviero Riggio, Lorenzo Ridola
Silvia Nardelli, Stefania Gioia, Jessica Faccioli, Oliviero Riggio, Lorenzo Ridola, Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome 00185, Italy
Author contributions: Nardelli S and Ridola L drafted the article; Nardelli S, Riggio O and Ridola L contributed to critical revision of the article for important intellectual content; Gioia S and Faccioli J contributed to acquisition of data; Ridola L contributed to conception and design; Riggio O and Ridola L contributed to final approval of the article.
Conflict-of-interest statement: There are no conflicts of interest arising from this work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Lorenzo Ridola, MD, PhD, Doctor, Department of Translational and Precision Medicine, “Sapienza” University of Rome, viale dell’Università 37, Rome 00185, Italy. lorenzo.ridola@uniroma1.it
Telephone: +39-773-6556155 Fax: +39-773-6556155
Received: July 2, 2019
Peer-review started: July 2, 2019
First decision: August 2, 2019
Revised: August 8, 2019
Accepted: August 24, 2019
Article in press: August 2, 2019
Published online: September 21, 2019
Abstract

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.

Keywords: Minimal hepatic encephalopathy, Cognitive impairment, Sarcopenia, Muscle alterations, Cirrhosis

Core tip: Minimal hepatic encephalopathy (MHE) represents the mildest type of hepatic encephalopathy, is very frequent, affecting from 20% up to 80% of patients tested, depending of the diagnostic tools used and 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. Sarcopenia has been recently proposed as a risk factor for both minimal and overt Hepatic Encephalopathy. Aim of this review is to summarize the most recently published evidences about the emerging relationship between sarcopenia and cognitive impairment.