Hepatitis C and cognitive impairment in a cohort of patients with mild liver disease

Authors

  • Daniel M. Forton,

    Corresponding author
    1. Hepatology Section, Division of Medicine A, Faculty of Medicine, Imperial College, St Mary's Hospital, London
    2. Robert Steiner Magnetic Resonance Unit, Clinical Sciences Centre, Imperial College, Hammersmith Hospital, London
    • Hepatology Section, Faculty of Medicine, Imperial College, 10th floor QEQM building, St. Mary's Hospital, South Wharf Rd, London W2 1NY, England. fax: (44) 207-724-9369.
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  • Howard C. Thomas,

    1. Hepatology Section, Division of Medicine A, Faculty of Medicine, Imperial College, St Mary's Hospital, London
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  • Christine A. Murphy,

    1. Hepatology Section, Division of Medicine A, Faculty of Medicine, Imperial College, St Mary's Hospital, London
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  • Joanna M. Allsop,

    1. Robert Steiner Magnetic Resonance Unit, Clinical Sciences Centre, Imperial College, Hammersmith Hospital, London
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  • Graham R. Foster,

    1. Hepatology Section, Division of Medicine A, Faculty of Medicine, Imperial College, St Mary's Hospital, London
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  • Janice Main,

    1. Hepatology Section, Division of Medicine A, Faculty of Medicine, Imperial College, St Mary's Hospital, London
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  • Keith A. Wesnes,

    1. Cognitive Drug Research Ltd, CDR House, Reading, Berkshire, England
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  • Simon D. Taylor-Robinson

    1. Hepatology Section, Division of Medicine A, Faculty of Medicine, Imperial College, St Mary's Hospital, London
    2. Robert Steiner Magnetic Resonance Unit, Clinical Sciences Centre, Imperial College, Hammersmith Hospital, London
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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.

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