Neuropsychological changes in a large sample of liver transplant candidates

One-hundred forty-eight pre-liver transplant candidates completed a psychological interview and brief neuropsychological testing. Assessment measures included the Repeatable Battery of Neuropsychological Status, Shipley Institute of Living Scale, Trail Making Test Parts A and B (TMT-A and TMT-B), and the Folstein Mini Mental State Exam. Participants in our sample scored in the Below Average range of functioning (mean score = 100; SD = 10) on measures of memory (mean = 89.51, SD = 17.43), attention (mean = 87.62, SD = 17.23), and spatial perception (mean = 88.69, SD = 20.39). Scores reflected moderate to severe impairment in organization and processing speed (TMT-B completion time in seconds: mean = 137.22, SD = 88.64). Controlling for the effects of prior education, MELD scores were strongly correlated with poorer performance on immediate and delayed memory subtests (both P < .01), as well as with diminished attentional capacity (P = .03). MELD scores also were significantly related to slower completion times on the TMT-A and TMT-B (both P < .05). Furthermore, independent sample t tests indicated that patients with higher MELD scores (>10) experienced significantly greater difficulty with executive functioning (P < .05) and delayed memory (P < .05) than those with lower MELD scores. Thorough evaluations of cognitive functioning are needed pretransplant to identify and treat cases of subclinical hepatic encephalopathy before daily functioning becomes significantly impaired.