Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-17T14:06:39.514Z Has data issue: false hasContentIssue false

Cognitive functioning and psychiatric symptomatology in patients with chronic hepatitis C

Published online by Cambridge University Press:  27 August 2003

Robin C. Hilsabeck*
Affiliation:
Department of Neuropsychiatry & Behavioral Science, Texas Tech University Health Sciences Center, Lubbock, Texas Department of Medicine, Division of Hepatology, University of California, San Diego, California Department of Psychiatry, University of California, San Diego, California
Tarek I. Hassanein
Affiliation:
Department of Medicine, Division of Hepatology, University of California, San Diego, California
Meghan D. Carlson
Affiliation:
Department of Medicine, Division of Hepatology, University of California, San Diego, California
Elizabeth A. Ziegler
Affiliation:
Department of Medicine, Division of Hepatology, University of California, San Diego, California
William Perry
Affiliation:
Department of Psychiatry, University of California, San Diego, California
*
Reprint requests to: Robin C. Hilsabeck, Ph.D., Department of Neuropsychiatry & Behavioral Science, Texas Tech University Health Sciences Center, 3601 4th Street, STOP 8321, Lubbock, TX 79430. E-mail: [email protected]

Abstract

Hepatitis C virus (HCV) infection is a major public-health-care problem, with over 170 million infected worldwide. Patients with chronic HCV infection often complain of various cognitive problems as well as symptoms of depression, anxiety, and fatigue. Relatively little is known, however, about the specific cognitive deficits that are common among HCV patients, and the influence of psychiatric symptomatology on cognitive functioning. In the current study of 21 chronically infected HCV patients, we assessed subjective cognitive dysfunction, depression, anxiety, and fatigue and compared these symptom areas to cognitive tests assessing visuoconstruction, learning, memory, visual attention, psychomotor speed, and mental flexibility. Results revealed that cognitive impairment ranged from 9% of patients on a visuoconstruction task to 38% of patients on a measure of complex attention, visual scanning and tracking, and psychomotor speed, and greater HCV disease severity as indicated by liver fibrosis was associated with greater cognitive dysfunction. Objective cognitive impairment was not related to subjective cognitive complaints or psychiatric symptomatology. These findings suggest that a significant portion of patients with chronic HCV experience cognitive difficulties that may interfere with activities of daily living and quality of life. Future research using cognitive measures with HCV-infected patients may assist researchers in identifying if there is a direct effect of HCV infection on the brain and which patients may be more likely to progress to cirrhosis and hepatic encephalopathy. (JINS, 2003, 9, 847–854.)

Type
Research Article
Copyright
Copyright © The International Neuropsychological Society 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alter, M.J., Kruszon-Moran, D., Nainan, O.V., McQuillan, G.M., Gao, F., Moyer, L.A., Kaslow, R.A., & Margolis, H.S. (1999). The prevalence of hepatitis C virus infection in the United States, 1988 through 1994. New England Journal of Medicine, 341, 556562.CrossRefGoogle ScholarPubMed
Armstrong, G.L., Alter, M.J., McQuillan, G.M., & Margolis, H.S. (2000). The past incidence of hepatitis C virus infection: Implications for the future burden of chronic liver disease in the United States. Hepatology, 31, 777782.CrossRefGoogle ScholarPubMed
Barkuizen, A., Rosen, H.R., Wolf, S., Flora, K., Benner, K., & Bennett, R.M. (1999). Musculoskeletal pain and fatigue are associated with chronic hepatitis C. American Journal of Gastroenterology, 94, 13551360.Google Scholar
Beck, A.T. & Steer, R.A. (1990). Beck Anxiety Inventory: Manual. San Antonio, Texas: The Psychological Corporation.Google Scholar
Beck, A.T., Steer, R.A., & Brown, G.K. (1996). Beck Depression Inventory–Second Edition: Manual. San Antonio, Texas: The Psychological Corporation.Google Scholar
Benedict, R.H.B. (1997). Brief Visuospatial Memory Test–Revised: Manual. Odessa, Florida: Psychological Assessment Resources.Google Scholar
Carbotte, R.M., Denburg, S.D., & Denburg, J.A. (1986). Prevalence of cognitive impairment in systemic lupus erythematosus. Journal of Nervous and Mental Disease, 174, 357364.CrossRefGoogle ScholarPubMed
Carbotte, R.M., Denburg, S.D., & Denburg, J.A. (1995). Cognitive dysfunction in systemic lupus erythematosus is independent of active disease. Journal of Rheumatology, 22, 863867.Google ScholarPubMed
Chang, L., Ernst, T., Leonido-Yee, M., Walot, I., & Singer, E. (1999). Cerebral metabolite abnormalities correlate with clinical severity of HIV-1 cognitive motor complex. Neurology, 52, 100108.CrossRefGoogle ScholarPubMed
Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155159.CrossRefGoogle ScholarPubMed
Dieperink, E., Willenbring, M., & Ho, S.B. (2000). Neuropsychiatric symptoms associated with hepatitis C and interferon alpha: A review. American Journal of Psychiatry, 157, 867876.CrossRefGoogle ScholarPubMed
Dwight, M.M., Kowdley, K.V., Russo, J.E., Ciechanowski, P.S., Larson, A.M., & Katon, W.J. (2000). Depression, fatigue, and functional disability in patients with chronic hepatitis C. Journal of Psychosomatic Research, 49, 311317.CrossRefGoogle ScholarPubMed
Ferenci, P., Lockwood, A., Mullen, K., Tarter, R., Weissenborn, K., Blei, & A.T., the Members of the Working Party. (2002). Hepatic encephalopathy—definition, nomenclature, diagnosis, and quantification: Final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology, 35, 716721.CrossRefGoogle Scholar
Fontana, R.J., Moyer, C.A., Sonnad, S., Lok, A.S.F., Sneed-Pee, N., Walsh, J., Klein, S., & Webster, S. (2001). Comorbidities and quality of life in patients with interferon-refractory chronic hepatitis C. American Journal of Gastroenterology, 96, 170177.CrossRefGoogle ScholarPubMed
Forton, D.M., Allsop, J.M., Main, J., Foster, G.R., Thomas, H.C., & Taylor-Robinson, S.D. (2001). Evidence for a cerebral effect of the hepatitis C virus. Lancet, 358, 3839.CrossRefGoogle ScholarPubMed
Forton, D.M., Thomas, H.C., Murphy, C.A., Allsop, J.M., Foster, G.R., Main, J., Wesnes, K.A., & Taylor-Robinson, S.D. (2002). Hepatitis C and cognitive impairment in a cohort of patients with mild liver disease. Hepatology, 33, 433439.CrossRefGoogle Scholar
Franklin, G.M., Heaton, R.K., Nelson, L.M., Filley, C.M., & Seibert, C. (1988). Correlation of neuropsychological and MRI findings in chronic/progressive multiple sclerosis. Neurology, 38, 18261829.CrossRefGoogle ScholarPubMed
Goh, J., Coughlan, B., Quinn, J., O'Keane, C., & Crowe, J. (1999). Fatigue does not correlate with the degree of hepatitis or the presence of autoimmune disorders in chronic hepatitis C infection. European Journal of Gastroenterology and Hepatology, 11, 833838.CrossRefGoogle ScholarPubMed
Grant, I., Prigatano, G.P., Heaton, R.K., McSweeny, A.J., Wright, E.C., & Adams, K.M. (1987). Progressive neuropsychologic impairments and hypoxemia: Relationship in chronic obstructive pulmonary disease. Archives of General Psychiatry, 44, 9991006.CrossRefGoogle Scholar
Heaton, R.K., Grant, I., Butters, N., White, D.A., Kirson, D., Atkinson, J.H., McCutchan, J.A., Taylor, M.J., Kelly, M.D., Ellis, R.J., Wolfson, T., Velin, R., Marcotte, T.D., Hesselink, J.R., Jernigan, T.L., Chandler, J., Wallace, M., Abramson, I., & The HNRC Group. (1995). The HNRC 500—neuropsychology of HIV infection at different disease stages. Journal of the International Neuropsychological Society, 1, 231251.CrossRefGoogle ScholarPubMed
Hilsabeck, R.C., Perry, W., & Hassanein, T.I. (2000). Severity and comorbidity of depression and anxiety in patients with chronic hepatitis C not receiving antiviral therapy. American Journal of Gastroenterology, 95, A348.10.1111/j.1572-0241.2000.02709.xCrossRefGoogle Scholar
Hilsabeck, R.C., Hickman, S., Boland, B., Williams, B., Boyd, C., Hassanein, T.I., & Perry, W. (2001). The pattern of memory deficits in patients with end stage liver disease. Journal of the International Neuropsychological Society, 7, 169.Google Scholar
Hilsabeck, R.C., Perry, W., & Hassanein, T.I. (2002). Neuropsychological impairment in patients with chronic hepatitis C. Hepatology, 33, 440446.10.1053/jhep.2002.31257CrossRefGoogle Scholar
Johnson, M.E., Fisher, D.G., Fenaughty, A., & Theno, S.A. (1998). Hepatitis C virus and depression in drug users. American Journal of Gastroenterology, 93, 785789.CrossRefGoogle ScholarPubMed
Krupp, L.B., LaRocca, N.G., Muir-Nash, J., & Steinberg, A.D. (1989). The fatigue severity scale. Archives of Neurology, 46, 11211123.CrossRefGoogle ScholarPubMed
Lauer, G.M. & Walker, B.D. (2001). Hepatitis C virus infection. New England Journal of Medicine, 345, 4152.CrossRefGoogle ScholarPubMed
Lee, D.H., Jamal, H., Regenstein, F.G., & Perrillo, R.P. (1997). Morbidity of chronic hepatitis C as seen in a tertiary care medical center. Digestive Diseases and Sciences, 42, 186191.10.1023/A:1018818012378CrossRefGoogle Scholar
Marcotte, T.D., Grant, I., Atkinson, J.H., & Heaton, R.K. (2001). Neurobehavioral complications of HIV infection. In Tarter, R.E., Butters, M., & Beers, S.R. (Eds.), Medical neuropsychology (2nd ed., pp. 85105). New York: Kluwer Academic/Plenum Publishers.Google Scholar
McCrea, M., Cordoba, J., Vessey, G., Blei, A.T., & Randolph, C. (1996). Neuropsychological characterization and detection of subclinical hepatic encephalopathy. Archives of Neurology, 53, 758763.CrossRefGoogle ScholarPubMed
Meyerhoff, D.J., Bloomer, C., Cardenas, V., Norman, D., Weiner, M.W., & Fein, G. (1999). Elevated subcortical choline metabolites in cognitively and clinically asymptomatic HIV+ patients. Neurology, 52, 9951003.10.1212/WNL.52.5.995CrossRefGoogle ScholarPubMed
Pliskin, N.H., Yurk, H.M., Ho, L.T., & Umans, J.G. (1996). Neurocognitive function in chronic hemodialysis patients. Kidney International, 49, 14351440.CrossRefGoogle ScholarPubMed
Reitan, R.M. & Wolfson, D. (1993). The Halstead–Reitan Neuropsychological Test Battery: Theory and clinical interpretation. Tucson, Arizona: Neuropsychology Press.Google Scholar
Smith, A. (1982). Symbol Digit Modalities Test (SDMT): Manual (Revised). Los Angeles, California: Western Psychological Services.Google Scholar
Starace, F., Baldassarre, C., Biancolilli, B., Fea, M., Serpelloni, G., Bartoli, L., & Maj, M. (1998). Early neuropsychological impairment in HIV-seropositive intravenous drug users: Evidence from the Italian Multicentre Neuropsychological HIV Study. Acta Psychiatrica Scandinavica, 97, 132138.CrossRefGoogle ScholarPubMed
Stout, J.C., Salmon, D.P., Butters, N., Taylor, M., Peavy, G., Heindel, W.C., Delis, D.C., Ryan, L., Atkinson, J.H., Chandler, J.L., Grant, I., & The HNRC Group. (1995). Decline in working memory associated with HIV infection. Psychological Medicine, 25, 12211232.10.1017/S0033291700033195CrossRefGoogle ScholarPubMed
Wechsler, D. (1997). Wechsler Adult Intelligence Scale–Third Revision. San Antonio, Texas: The Psychological Corporation.Google Scholar
White, D.A., Heaton, R.K., Monsch, A.U., & The HNRC Group. (1995). Neuropsychological studies of asymptomatic human immunodeficiency virus-type-1 infected individuals. Journal of the International Neuropsychological Society, 1, 304315.CrossRefGoogle ScholarPubMed
Working Group of the American Academy of Neurology AIDS Task Force. (1991). Nomenclature and research case definitions for neurologic manifestations of human immunodeficiency virus-type 1 (HIV-1) infection. Neurology, 41, 778785.CrossRefGoogle Scholar
World Health Organization in collaboration with the Viral Hepatitis Prevention Board. (1999). Global surveillance and control of hepatitis C. Journal of Viral Hepatitis, 6, 3547.CrossRefGoogle Scholar
Wu, A.W., Rubin, H.R., Mathews, W.C., Ware, J.E., Brysk, L.T., Hardy, W.D., Bozzette, S.A., Spector, S.A., & Richman, D.D. (1991). A health status questionnaire using 30 items from the Medical Outcomes Study. Medical Care, 29, 786798.CrossRefGoogle ScholarPubMed
Zachary, R.A. (1986). Shipley Institute of Living Scale: Revised Manual. Los Angeles, California: Western Psychological Services.Google Scholar