摘要
Cognitive dysfunction in patients with chronic hepatitis C virus(HCV) infection is a distinct form of minimal hepatic encephalopathy(MHE). In fact, the majority of HCV-positive patients, irrespective of the grading of liver fibrosis, display alterations of verbal learning, attention, executive function, and memory when they are evaluated by suitable neuropsychological tests. Similarities between the cognitive dysfunction of HCV patients and MHE of patients with different etiologies are unclear. It is also unknown how the metabolic alterations of advanced liver diseases interact with the HCV-induced cognitive dysfunction, and whether these alterations are reversed by antiviral therapies. HCV replication in the brain may play a role in the pathogenesis of neuroinflammation. HCV-related brain dysfunction may be associated with white matter neuronal loss, alterations of association tracts and perfusion. It is unclear to what extent, in patients with cirrhosis, HCV triggers an irreversible neurodegenerative brain damage. New insights on this issue will be provided by longitudinal studies using the protocols established by the diagnostic and statistical manual of mental disorders fifth edition for cognitive disorders. The domains to be evaluated are complex attention; executive functions; learning and memory; perceptual motor functions; social cognition. These evaluations should be associated with fluorodeoxyglucose positron emission tomography and magnetic resonance imaging(MRI) protocols for major cognitive disorders including magnetic resonance spectroscopy, diffusion tensor imaging, magnetic resonance perfusion, and functional MRI. Also, the characteristics of portal hypertension, including the extent of liver blood flow and the type of portal shunts, should be evaluated.
Cognitive dysfunction in patients with chronic hepatitisC virus （HCV） infection is a distinct form of minimalhepatic encephalopathy （MHE）. In fact, the majority ofHCV-positive patients, irrespective of the grading of liverfibrosis, display alterations of verbal learning, attention,executive function, and memory when they are evaluatedby suitable neuropsychological tests. Similarities betweenthe cognitive dysfunction of HCV patients and MHE ofpatients with different etiologies are unclear. It is alsounknown how the metabolicalterations of advancedliver diseases interact with the HCV-induced cognitivedysfunction, and whether these alterations are reversedby antiviral therapies. HCV replication in the brain mayplay a role in the pathogenesis of neuroinflammation.HCV-related brain dysfunction may be associated withwhite matter neuronal loss, alterations of associationtracts and perfusion. It is unclear to what extent, inpatients with cirrhosis, HCV triggers an irreversibleneurodegenerative brain damage. New insights on thisissue will be provided by longitudinal studies using theprotocols established by the diagnostic and statisticalmanual of mental disorders fifth edition for cognitivedisorders. The domains to be evaluated are complexattention; executive functions; learning and memory;perceptual motor functions; social cognition. Theseevaluations should be associated with fluorodeoxyglucosepositron emission tomography and magnetic resonanceimaging （MRI） protocols for major cognitive disordersincluding magnetic resonance spectroscopy, diffusiontensor imaging, magnetic resonance perfusion, andfunctional MRI. Also, the characteristics of portalhypertension, including the extent of liver blood flow andthe type of portal shunts, should be evaluated.
