TY  - JOUR
PY  - 2015//
TI  - Alterations in Cerebral White Matter and Neuropsychology in Patients with Cirrhosis and Falls
JO  - PLoS one
A1  - Gómez-Ansón, Beatriz
A1  - Román, Eva
A1  - Fernández de Bobadilla, Ramón
A1  - Pires-Encuentra, Patricia
A1  - Díaz-Manera, Jordi
A1  - Núñez, Fidel
A1  - Martinez-Horta, Saül
A1  - Vives-Gilabert, Yolanda
A1  - Pagonabarraga, Javier
A1  - Kulisevsky, Jaume
A1  - Córdoba, Juan
A1  - Guarner, Carlos
A1  - Soriano, Germán
SP  - e0118930
EP  - e0118930
VL  - 10
IS  - 3
N2  - BACKGROUND & AIM: Falls are frequent in patients with cirrhosis but underlying mechanisms are unknown. The aim was to determine the neuropsychological, neurological and brain alterations using magnetic resonance-diffusion tensor imaging (MR-DTI) in cirrhotic patients with falls. <br><br>PATIENTS AND METHODS: Twelve patients with cirrhosis and falls in the previous year were compared to 9 cirrhotic patients without falls. A comprehensive neuropsychological and neurological evaluation of variables that may predispose to falls included: the Mini-Mental State Examination, Psychometric Hepatic Encephalopathy Score (PHES), Parkinson's Disease-Cognitive Rating Scale, specific tests to explore various cognitive domains, Unified Parkinson's Disease Rating Scale to evaluate parkinsonism, scales for ataxia and muscular strength, and electroneurography. High-field MR (3T) including DTI and structural sequences was performed in all patients. <br><br>RESULTS: The main neuropsychological findings were impairment in PHES (p = 0.03), Parkinson's Disease-Cognitive Rating Scale (p = 0.04) and in executive (p<0.05) and visuospatial-visuoconstructive functions (p<0.05) in patients with falls compared to those without. There were no statistical differences between the two groups in the neurological evaluation or in the visual assessment of MRI. MR-DTI showed alterations in white matter integrity in patients with falls compared to those without falls (p<0.05), with local maxima in the superior longitudinal fasciculus and corticospinal tract. These alterations were independent of PHES as a covariate and correlated with executive dysfunction (p<0.05). <br><br>CONCLUSIONS: With the limitation of the small sample size, our results suggest that patients with cirrhosis and falls present alterations in brain white matter tracts related to executive dysfunction. These alterations are independent of PHES impairment.<p />  <p>Language: en</p>
LA  - en
SN  - 1932-6203
UR  - http://dx.doi.org/10.1371/journal.pone.0118930
ID  - ref1
ER  -