Effects of Illness Severity and Alcohol Use on Cognition in End Stage Liver Disease after Controlling for General Intelligence and Mood——Cognition in End Stage Liver Disease

Background: While neuropsychological deficits are common in patients with end stage liver disease (ESLD) evaluated for transplantation, the determinant factors are not clear. Methods: Towards that end, we examined data from 108 patients who completed neuropsychological tests as part of their liver transplantation evaluation. First, controlling for estimated premorbid ability and mood, multiple regression analyses were used to examine the effects of illness severity on cognition. Second, we compared neuropsychological functioning of patients with vs. without a history of excessive alcohol use, independent of primary liver disease diagnosis. Results: Severity of illness was associated with the extent of psychomotor slowing. Excessive alcohol use was associated with lower scores on tests of memory. Furthermore, worse memory was not explained by lower estimated premorbid ability, lower concurrently measured general intelligence, or greater illness severity. Conclusions: Our findings illustrate the importance of controlling for estimated premorbid ability in assessing the effect of illness variables on cognition. Another implication is that measures of psychomotor speed are important in assessing cognition in patients with ESLD, and especially for patients with a history of excessive alcohol use, a broader range of domains, including memory, should be examined.