Executive Functions in Minimal Hepatic Encephalopathy

*Bruno Peixoto¹, Laudino Lopez², Jorge Areias³, Rute Cerqueira⁴, Jorge Arias²

Summary
Minimal hepatic encephalopathy (MHE) is a clinical condition of the hepatic encephalopathy spectrum that is not easily identified on a routine neurological examination. Nevertheless, deficits can be exposed through a more detailed neuropsychological or neurophysiological assessment. Executive functioning (EF) in this condition has not been fully explored.
Aim. We aim to identify EF impairments in the spectrum of hepatic cirrhosis and its distribution among mild, moderate and severe levels of the disease.
Materials and methods. Our sample is divided into three experimental groups based on the Child-Pugh classification of hepatic cirrhosis severity: Child A group (n=20), Child B group (n=20) and Child C group (n=20), and a control group (n=20).
Results. All the participants had normal results in the Mini Metal State Examination. The Behavioural Assessment of the Dysexecutive Syndrome battery and the Wisconsin Card Sorting Test were used in order to assess the EF. Our results enabled an executive profile of the MHE in the spectrum of cirrhosis. In the mild and moderate stages of liver dysfunction, we observed deficits in ability to inhibit previous associations and to use feedback in order to correct behaviour. With the progression of the liver disease, there is an increase of those deficits. Meanwhile, considerable deficits in cognitive estimation, organization and maintenance of behaviour through a certain period of time and structured planning were found at all levels of hepatic cirrhosis.

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