Cognitive impairment in alcoholic and nonalcoholic cirrhotic patients

Cognitive impairment is common in patients with advanced liver disease. It has been suggested that patients with alcoholic liver disease (ALD) have mo re impaired cognition than nonalcoholics. The objective of this study was t o characterize any differences in cognitive functions between alcoholic cir rhotic patients and non-alcoholic cirrhotic patients of similar age, educat ion, and severity of liver disease. We assessed cognitive functions in 117 patients with alcoholic cirrhosis; and 163 patients with nonalcoholic cirrh osis using a brief battery of neuropsychological tests. In addition, all pa tients had standard psychiatric examinations to assess the effect of the di sease severity, alcoholism, anxiety, and depression on the test scores. The study showed a higher proportion of patients with cognitive impairment in the alcoholic group. Alcoholics performed poorly in tests of memory and mot or speed compared with nonalcoholics, despite similar premorbid IQ and educ ation. Because patients with alcoholic cirrhosis had more severe liver dise ase (Child-Pugh score 8.5 +/- 2.2 vs. 7.6 +/- 2.2, P = .03) than nonalcohol ics, the results were reanalyzed after adjusting for the linear effects of Child-Pugh score on cognitive test scores, We also used two-way analysis of variance to examine the interaction between Child class and alcoholism. Fi nally, the test scores were compared within each Child class. These analyse s revealed no primary or interaction effect of alcoholism and confirmed tha t the differences in the test scores observed in alcoholics reflect the gre ater severity of their liver disease. The severity of cognitive impairment is similar in both alcoholic and non-alcoholic cirrhotic patients when adju sted for the severity of liver disease.