Studying cognition impairment in patients with minimal hepatic encephalopathy through functional connectivity analysis: evidence from resting-state functional MRI.

AIM

This study aimed to investigate functional connectivity (FC) alterations between the insula and other brain regions in minimal hepatic encephalopathy (MHE) patients and their association with cognitive deficits.

MATERIALS AND METHODS

The study included 23 MHE patients and 25 healthy control (HC) individuals. All participants underwent resting-state functional magnetic resonanceimaging (fMRI), neuropsychological testing, and cognitive scale assessments. FC analysis was performed to investigate the connectivity between the insula and the whole brain in the context of MHE. Pearson correlation analysis was conducted to assess the association between changes in FC and cognitive scale scores.

RESULTS

The HC and MHE groups showed significant differences in cognitive performance measures, such as the Number Connection Test-A (NCT-A), Digit symbol Test (DST), and Montreal Cognitive Assessment (MoCA) score (P < 0.01). The MHE group demonstrated elevated FC between the right insula and the right superior frontal gyrus, right middle frontal gyrus, and right precentral gyrus compared with the HC group. Furthermore, the left insula showed increased FC with the left middle frontal gyrus and the right middle frontal gyrus (P < 0.05, corrected). Notably, these changes in FC among MHE patients were significantly correlated with the MoCA score (P < 0.05, corrected).

CONCLUSION

This study emphasises the FC alterations between the insula and the prefrontal cortex in MHE patients, which have a close association with cognitive functions. FC could potentially serve as a biomarker for diagnosing and assessing the severity of cognitive impairments in MHE.