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Updated: Aug 5, 2026

Mouse Model of Metabolic Dysfunction-Associated Steatotic Liver Disease with Fibrosis
Published on: July 18, 2025
Cognitive impairment in metabolic dysfunction-associated steatotic liver disease (MASLD): A systematic review and
Soe Thiha Maung1, Solaphat Hemrungrojn2, Roongruedee Chaiteerakij3
1Division of Graduate Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Ma Har Myaing Hospital, Yangon, Myanmar.
Objective:
This systematic review and meta-analysis aimed to evaluate cognitive performance in individuals with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) compared to controls and to explore how cognitive assessment methods and metabolic risk factors may influence the relationship between MASLD and cognitive impairment.
Methods:
We systematically searched databases through June 2026 for studies comparing cognitive performance in MASLD patients using Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA). We calculated pooled standardized mean differences (SMDs) using random-effects meta-analysis and explored heterogeneity via subgroup and meta-regression analyses.
Results:
We included 13 studies involving 15,545 participants. The pooled SMD for cognitive scores in NAFLD/MASLD patients vs. controls was -0.43 (95%CI: -0.61 to -0.25; p < 0.0001; I2 = 83%), indicating a statistically significant association with poorer cognitive performance. Subgroup analysis showed significant effects in both MoCA-based (SMD = -0.59; 95%CI: -0.93 to -0.25; p < 0.001; I2 = 90%) and MMSE-based studies (SMD = -0.20; 95%CI: -0.24 to -0.16; p < 0.001; I2 = 53%), with a significant between-subgroup difference (p = 0.024). Cross-sectional studies reported stronger effects with higher heterogeneity (SMD = -0.52; 95%CI: -0.75 to -0.29; p < 0.001), whereas cohort studies showed smaller but consistent results (SMD = -0.19; 95%CI: -0.25 to -0.13; p < 0.001). Meta-regression identified that higher BMI (β = -0.071; R2 = 81%) and increased liver enzymes, specifically AST (β = -0.038; R2 = 98%), ALT (β = -0.018; R2 = 100%), and GGT (β = -0.012; R2 = 90%), were strongly associated with lower cognitive scores.
Conclusion:
This meta-analysis demonstrated a statistically significant association between NAFLD/MASLD and poorer cognitive performance, with BMI and elevated liver enzymes identified as key moderators, supporting for routine MoCA-based cognitive screening in high-risk populations and standardized longitudinal research.
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