HEPATIC ENCEPHALOPATHY--NEUROPSYCHOLOGY & NEUROCHEMISTRY

肝性脑病--神经心理学

• 批准号: 2902313
• 负责人: MICHAEL Albert THOMAS
• 金额: $ 27.19万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-08-05 至 2002-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2902313
• 关键词: choline; clinical research; diagnosis design /evaluation; glutamates; glutamine; hepatic coma /encephalopathy; human subject; liver cirrhosis; magnetic resonance imaging; neurochemistry; neuropsychological tests; neuropsychology; nuclear magnetic resonance spectroscopy

DESCRIPTION: (Verbatim from the Applicant's Abstract) Hepatic Encephalopathy (HE) is a well-recognized complication of cirrhosis. These patients display a variety of neuropsychological deficits as well as clinical and serum ammonia abnormalities. Sub-clinical hepatic Encephalopathy (SHE) is a subtler accompaniment of cirrhosis that is associated with neuropsychological abnormalities without significant neurologic findings such as asterixis. Although neuropsychological tests are the current standard for diagnosing SHE, the results are non-specific and reveal little about the underlying neurochemical processes. Cerebral Magnetic Resonance Spectroscopic (MRS) metabolic alterations and MRI signal abnormalities in the basal ganglia reveal a relationship between neuropsychological functioning and biochemical abnormalities found in patients with SHE. This study will involve collaboration among hematologists, radiologists, psychiatrists, MR physicists and neuropsychologists. We will identify a total of 60 liver failure patietns who have SHE and compare them to 60 healthy control subjects. These patients and healthy controls will undergo clinical assessment by hepatologists and neuropsychiatric evaluation by psychiatrists. Subsequently, they will undergo a comprehensive series of neuropsychological tests to characterize the nature of their neurocognitive deficits. Following these tests, all subjects will undergo MR Imaging and Spectroscopic (MRI/MRS) examinations. We aim to use 1H MRS to meare and compare absolute cerebral metabolite levels of myo-inositol, choline, and glutamine/glutamate in the frontal lobe, parietal lobe and basal ganglia of a matched group of SHE patients and healthy controls. The resulting MRS and MRI data will be quantitatively analyzed and correlated with the results of neuropsychological testing and clinical examination. Multivariate methods and correlational analysis will be used to test hypotheses regarding differences between SHE patients and controls. We hypothesize that myo-inositol will be decreased, glutamine/glutamate will be increased and choline will be decreased in patietns with SHE. We propose that these underlying biochemical abnormalities will be correlated with clinical, neuropsychiatric and neuropsychological aspects of SHE. If these relationships are found, they will provide an improved biochemical understanding of the underlined aspects of SHE as characterized y clinical and neuropsychological testing. This enhanced understanding of pathophysiology will improve our ability to diagnose and treat this condition, resulting in improved patient outcomes.

描述：（申请人摘要的逐字化）肝性脑病 （HE）是一种公认​​的肝硬化并发症。这些患者显示 神经心理学缺陷以及临床和血清氨的种类 异常。亚临床肝脑病（她）是一个微妙的 与神经心理学有关的肝硬化的伴奏 没有明显的神经系统发现（例如紫杉醇）的异常。 尽管神经心理学测试是当前诊断她的标准，但 结果是非特异性的，几乎没有透露基础 神经化学过程。脑磁共振光谱（MRS） 基底神经节中的代谢改变和MRI信号异常揭示 神经心理功能与生化之间的关系 SHE患者发现异常。这项研究将涉及合作 血液学家，放射科医生，精神科医生，物理学家和 神经心理学家。我们将确定共有60个肝衰竭的人 让她与60个健康对照对象进行比较。这些患者和 健康的控制措施将接受肝病学家的临床评估 精神科医生的神经精神病学评估。随后，他们将经历 全面的神经心理学测试，以表征 他们的神经认知缺陷。按照这些测试，所有受试者都会接受 MR成像和光谱学（MRI/MRS）检查。我们的目标是使用1H MRS Meare并比较肌醇的绝对大脑代谢物水平，胆碱， 额叶，顶叶和基底神经节中的谷氨酰胺/谷氨酸 一群她的患者和健康对照组。由此产生的MRS和MRI 数据将进行定量分析并与 神经心理学测试和临床检查。多元方法和 相关分析将用于检验有关差异的假设 在她的患者和对照之间。我们假设myo-肌醇将是 减少，谷氨酰胺/谷氨酸将增加，胆碱将减少 和她在一起。我们建议这些基本的生化 异常将与临床，神经精神病学和 她的神经心理学方面。如果找到这些关系，他们将 对她的下划线方面提供了改进的生化理解 如Y临床和神经心理学测试的特征。这增强了 了解病理生理学将提高我们诊断和治疗的能力 这种情况，导致患者的预后改善。