Neuroendocrine and emotional predictors of verbal fluency impairment in chronic liver disease: A Cross-Sectional Study

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Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions

Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions

Published on: April 23, 2021

Daniela Batallas¹, Pablo Rivas-Diaz¹, David Trillo-Figueroa¹

¹Laboratory of Social Cognitive Neuroscience, Department of Psychobiology and IDOCAL, University of Valencia, Valencia, Spain.

Journal of Psychosomatic Research

|July 14, 2026

Abstract

Background & Aims:

Cirrhosis is increasingly recognized as a condition affecting neuroendocrine regulation, emotional functioning, and cognitive performance. Altered cortisol physiology has been documented in cirrhosis, yet its cognitive and emotional consequences remain insufficiently understood. This study examined whether cortisol reactivity predicts verbal fluency (VF) performance and whether difficulties in emotion regulation mediate this association, comparing cirrhotic patients with healthy controls.

Methods:

Twenty-eight cirrhotic patients (mean age = 63.4 years, SE = 1.4) and thirty-three controls (mean age = 68.1 years, SE = 1.0) completed phonemic (PVF) and semantic (SVF) verbal fluency tasks, the Difficulties in Emotion Regulation Scale (DERS), and provided salivary samples to measure cortisol before and after a standardized neuropsychological evaluation. Cortisol reactivity was computed as post minus baseline change. Moderated mediation models tested whether emotion regulation mediated the cortisol reactivity-VF relationship and whether these pathways differed across groups.

Results:

Baseline cortisol levels did not differ significantly between groups, but the cirrhotic patients showed significantly higher post-assessment cortisol concentrations than controls. Patients also displayed lower VF performance and greater emotion regulation difficulties. For PVF, higher cortisol reactivity predicted poorer performance in cirrhotic patients indirectly through higher emotion dysregulation, whereas no such effects emerged in controls. For SVF, no significant direct or indirect effects were observed.

Conclusions:

These results suggest that altered cortisol regulation and emotion regulation difficulties may contribute to poorer PVF performance associated with cirrhosis. The findings further highlight emotion regulation as a potentially relevant mechanism linking stress-related physiological responses and cognitive vulnerability in chronic liver disease.

Keywords:

Cortisol reactivity Emotion regulation Liver cirrhosis Verbal fluency

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