Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA.
Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, USA.
Eur J Neurol. 2020 Oct;27(10):1895-1903. doi: 10.1111/ene.14384. Epub 2020 Jul 20.
Liver fibrosis, a common yet often subclinical manifestation of chronic liver disease, may have an unrecognized role in cognitive impairment. We evaluated the association between a validated liver fibrosis index and cognitive measures among older adults.
We examined the association between liver fibrosis and cognitive performance among participants aged 60 years and older in the US National Health and Nutrition Examination Survey. Liver fibrosis was measured with the validated Fibrosis-4 (FIB-4) liver fibrosis score. The outcomes were performance on four standardized cognitive tests of immediate and delayed verbal learning, verbal fluency, and attention/concentration. We used linear regression to evaluate the association between FIB-4 score and performance on cognitive tests while adjusting for potential confounders. In sensitivity analyses, we examined this association in participants without known liver disease.
Among 3217 adult participants, the mean age was 69 years, and 54% were women. Standard liver chemistries were largely in the normal range. However, 5.0% [95% confidence interval (CI) 4.0-6.0] had liver fibrosis based on a validated cut-off. In adjusted linear regression models, higher liver fibrosis scores were associated with worse immediate recall (β -0.39; 95% CI -0.58, -0.21), language fluency (β -0.46; 95% CI -0.72, -0.21), and attention/concentration (β -1.34; 95% CI -2.25, -0.43), but not delayed recall (β -0.10; 95% CI -0.20, 0.01). Results were similar when limiting the study population to participants without known clinical liver disease.
Liver fibrosis, including subclinical liver fibrosis, may be an independent risk factor for cognitive impairment among older adults.
肝纤维化是慢性肝病常见但通常处于亚临床状态的一种表现，它可能在认知障碍中起着尚未被认识到的作用。我们评估了经证实的肝纤维化指数与老年人认知测量值之间的相关性。
我们在美国国家健康和营养调查中检查了年龄在 60 岁及以上的参与者中肝纤维化与认知表现之间的关系。使用经过验证的纤维化-4（FIB-4）肝纤维化评分来测量肝纤维化。结果是即时和延迟言语学习、言语流畅性和注意力/集中力四项标准化认知测试的表现。我们使用线性回归来评估 FIB-4 评分与认知测试表现之间的关联，同时调整潜在的混杂因素。在敏感性分析中，我们在没有已知肝病的参与者中检查了这种关联。
在 3217 名成年参与者中，平均年龄为 69 岁，54%为女性。标准的肝功能检查结果大多在正常范围内。然而，根据经证实的截断值，有 5.0%（95%置信区间 4.0-6.0）存在肝纤维化。在调整后的线性回归模型中，较高的肝纤维化评分与即时回忆（β-0.39；95%置信区间-0.58，-0.21）、语言流畅性（β-0.46；95%置信区间-0.72，-0.21）和注意力/集中力（β-1.34；95%置信区间-0.25，-0.43）较差相关，但与延迟回忆（β-0.10；95%置信区间-0.20，0.01）无关。当将研究人群限制在没有已知临床肝病的参与者时，结果相似。
肝纤维化，包括亚临床肝纤维化，可能是老年人认知障碍的一个独立危险因素。
