Autonomic and cognitive disturbances in patients with non-alcoholic fatty liver disease and type 2 diabetes mellitus
Background. There are multifunctional researches for better understanding the effect of cognitive disorders on treatment, mobility, mortality of patients, especially persons with multimorbid pathology. The purpose was to study the features of cognitive and neurovegetative dysfunction in patients with different forms of non-alcoholic fatty liver disease (NAFLD) (non-alcoholic fatty hepatosis (NAFH) and non-alcoholic steatohepatitis (NASH)) and type 2 diabetes mellitus (T2DM). Materials and methods. Fifty patients with NAFLD (24 — with NAFH and 26 — with NASH) were examined. The comparison group included 22 patients with T2DM. Dysfunction of central and autonomic nervous system was evaluated with the help of neuropsychometric testing. Results. The analysis of conducted research indicates autonomic dysfunction in the surveyed patients. Cognitive impairment (mostly mild and moderate) was detected in all persons in both groups. The most pronounced disturbances were determined in the areas of attention and concentration, memory, less pronounced — in visually constructive area, especially in patients with NASH combined with type 2 diabetes. Stressful situations have a significant impact on the lives of these persons, but they are not critical enough to any issues. Patients with NASH associated with type 2 diabetes have the lowest level of resistance to stress — (56.7 ± 3.1) points; p < 0.01. They experienced a slight vulnerability even from minor impacts. Conclusions. According to neuropsychometric testing, cognitive impairment and autonomic dysfunction were found in patients with NAFLD and type 2 diabetes. The most pronounced cognitive impairment was found in patients with NASH combined with type 2 diabetes and obesity class I, according to the results of the Montreal Cognitive Assessment (r = 0.90; p < 0.01), the Boston test (r = 0.94; p < 0.01) and the Wisconsin Card Sorting Test (r = 0.92; p < 0.01).
Snowden МB, Steinman LE, Bryant LL, et al. Dementia and co-occurring chronic conditions: a systematic literature review to identify what is known and where are the gaps in the evidence. Int J Geriatr Psychiatry. 2017 Apr;32(4):357-371. doi: 10.1002/gps.4652.
Gesualdo GD, Duarte JG, Zazzetta MS, et al. Cognitive impairment of patients with chronic renal disease on hemodialysis and its relationship with sociodemographic and clinical characteristics. Dement Neuropsychol. 2017 Jul-Sep;11(3):221-226. doi: 10.1590/1980-57642016dn11-030003.
Okur Güney ZE, Sattel H, Witthöft M, Henningsen P. Emotion regulation in patients with somatic symptom and related disorders: A systematic review. PLoS One. 2019 Jun 7;14(6):e0217277. doi: 10.1371/journal.pone.0217277.
European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the Management of Non-Alcoholic Fatty Liver Disease. Obes Facts. 2016;9(2):65-90. doi: 10.1159/000443344.
Stepanov YuM, Nedzvetskaya NV, Yagmur VB, Klenina IA Non-alcoholic fatty liver disease: features of metabolic changes at different stages of the disease. Gastroenterologìa. 2018;52(1):1-6. doi: 10.22141/2308-2097.52.1.2018.130772. (in Ukrainian).
Gan L, Chitturi S, Farrell GC. Mechanisms and Implications of Age-Related Changes in the Liver: Nonalcoholic Fatty Liver Disease in the Elderly. Curr Gerontol Geriatr Res. 2011;2011:831536. doi: 10.1155/2011/831536.
Filipoviс B, Markoviс O, Duric V, Filipovic B. Cognitive Changes and Brain Volume Reduction in Patients with Nonalcoholic Fatty Liver Disease. Can J Gastroenterol Hepatol. 2018 Feb 27;2018:9638797. doi: 10.1155/2018/9638797.
World Health Organization. Global Database on Body Mass Index (BMI). Available from: https://www.who.int/nutrition/databases/bmi/en/.
European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD) and European Association for the Study of Obesity (EASO) EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016 Jun;64(6):1388-402. doi: 10.1016/j.jhep.2015.11.004.
Akhutina TV, Melikyan ZA. Neuropsychological Assessment: an overview of modern tendencies (dedicated to 110-th anniversary of A.R. Luria). Klinicheskaia i spetsial'naia psikhologiia. 2012;1(2):1-18. (in Russian).
Nasonova TI, Klimenko OV, Kolosova TV, et al. Neurovegetative and cognitive impairments associated with anxiety in middle-aged patients with underlying cerebrovascular diseases. Family medicine. 2017;(70):97-102. (in Ukrainian).
Stewart KE, Haller DL, Sargeant C, Levenson JL, Puri P, Sanyal AJ. Readiness for behaviour change in non-alcoholic fatty liver disease: implications for multidisciplinary care models. Liver Int. 2015 Mar;35(3):936-43. doi: 10.1111/liv.12483.
Sirchak YeS, Griga VI, Kurchak NYu, Kutsenko AYu. Changes in the brain vessels in patients with non-alcoholic fatty liver disease and carbohydrate metabolism disorders. Gastroenterologìa. 2019;53(2):98-105. doi: 10.22141/2308-2097.53.2.2019.168983. (in Ukrainian).
Copyright (c) 2019 GASTROENTEROLOGY
This work is licensed under a Creative Commons Attribution 4.0 International License.
© Publishing House Zaslavsky, 1997-2020