Brain Regions Increase Activity Following Liver Transplantation, Cognition Improves

By Annette Boyle and Brenda Mooney, MDalert.com contributors.

Save to PDF November 17, 2015 By <em>By Annette Boyle and Brenda Mooney, MDalert.com contributors.</em>

San Francisco—Liver transplants improvement of cognitive function for individuals with cirrhosis, but exactly how and why has remained unclear. Now researchers report that marked improvement on a variety of cognitive tests correlate with changes in brain activity seen in functional magnetic resonance imaging (fMRI).

V Ahluwalia and colleagues performed cognitive testing on patients with cirrhosis who were also on the transplant list. The researchers asked patients to complete questionnaires regarding depression and quality of life before and 6 months after liver transplantation. Cognitive tests included number connection A/B (trail-making), digit-symbol, and block design tests to evaluate psychomotor speed, set-shifting, and visuo-motor coordination. Dr. Ahluwalia presented the findings in poster 52 at the 2015 annual meeting of the AASLD, held here recently. Click here to access the entire abstract.

**Figure 1.** The Wisconsin Card Sorting Test is a neuropsychological test of *set-shifting.*

The researchers also performed brain functional MRI while subjects underwent an inhibitory control test within the scanner. The inhibitory control test measures response inhibition, working memory, and psychomotor speed. The outcomes were lures that were to be inhibited and targets to which the subjects were to respond. Changes in brain activation on correct-lure inhibition and target response were compared before and after liver transplantation.

Patients (n=39) underwent testing before and after transplantation. The researchers found significant improvement in all measures of psychological and psychosocial health and quality of life, as well as notable improvement in cognitive performance on all tests.

The fMRI analysis showed a significantly improved correct-lure inhibition (pre 34 vs post 37, P=0.02), which was associated with greater activation of the basal ganglia, fronto-parietal, and cingulate gyri that mediate information processing and executive function. Improvements in target response (94% to 97%) were associated with activation of areas that mediate vigilance, language, and arousal, including the anterior cingulate, frontal pole, angular gyrus, supra marginal, and parietal lobule and insula.

AASLD The Liver Meeting® 2015 Conference Research Round-Up