Neurológia pre prax 3/2016

Cognitive impairment in gastrointestinal and hepatic diseases

Cognitive impairment in gastrointestinal disorders is mostly seen in the context of neurological manifestations of Whipple´s disease and as a result of nutrition deficits with hypovitaminosis B1 and B12. Korsakoff´s syndrome usually manifests after diminution of motor manifestations in Wernicke´s encephalopathy and typically presents severe anterograde and retrograde amnesia with confabulations, short term memory and judgement are preserved. Routine assessment of B12 plasmatic levels is no more recommended for dementia screening in general practice. Hepatic encephalopathy may develop in acute liver failure, in portocaval shunt and in hepatic cirrhosis, with two principal forms: manifest hepatic encephalitis with clinical signs and minimal hepatic encephalitis with normal clinical examination but impairment in neuropsychological testing. Wilson´s disease may manifest with neuropsychiatric symptoms, however, cognitive impairment is found only in patient with neurological manifestations of Wilson’s disease.

Keywords: Whipple´s disease, Wernicke´s encephalopathy, Korsakoff´s syndrome, hepatic encephalopathy, hypovitaminosis B12, Wilson’s disease