In patients with cirrhosis, cognitive dysfunction most often results from covert hepatic encephalopathy.
These patients are not tested routinely for cognitive dysfunction despite single-center evidence that it could be associated with poor socioeconomic status (SES).
Dr Jasmohan Bajaj and colleagues from Virginia, USA investigated the association between socioeconomic status and cognition in a multicenter study of cirrhosis.
The team performed a cross-sectional study, 236 cirrhotic patients from 3 centers 4 subjects from Virginia, 102 from Ohio, and 50 from Rome, Italy.
The patients were given recommended cognitive tests and a validated socioeconomic status questionnaire that included questions about employment, personal and family income, and overall financial security.
Comparisons were made among centers and between subjects who were employed or not.
|37% of subjects had been employed in the past year|
|Clinical Gastroenterology & Hepatology|
Regression analysis was performed using employment and personal income as outcomes.
The research team found that only 37% of subjects had been employed in the past year.
Subjects had substantial financial insecurity—their yearly personal income ranged from $16,000 to $24,999, and their family income ranged from $25,000 to $49,999.
They would be able to maintain a residence for only 3 to 6 months if their income stopped, and their current liquid assets were $500 to $4999.
Cognition and socioeconomic status were worst in Ohio and best in Virginia.
Cognition correlated with personal and family income, within and between centers.
On regression analysis, cognitive performance was associated with personal yearly income, after controlling for demographics, country, employment, and overt hepatic encephalopathy.
The team found that unemployed subjects had a higher rate of overt hepatic encephalopathy, worse cognition, and lower personal income than employed subjects.
The researchers observed that performance on digit symbol, line tracing, inhibitory control test lures, and serial dotting tests remained associated with employment, similar to income.
Dr Bajaj's team concludes, "In an international multicenter study of patients with cirrhosis, socioeconomic condition, based on employment and personal income, was associated strongly with cognitive performance, independent of age, education, and country."