Alteraciones neurológicas en pacientes cirróticos con Encefalopatía Hepática Mínima. Implicación de la inflamación y el estrés oxidativo

Hepatic encephalopathy (HE) is a complex neuropsychiatric syndrome secondary to liver cirrhosis, showing a significant incidence (33-50%). There is a subclinical stage called Minimal Hepatic Encephalopathy (MHE) in which the patient shows no obvious symptoms of HE but does shows cognitive and motor impairment and a potential risk of hospitalization due to cognitive impairment. The method of diagnosis of MHE used as a 'gold standard' consists in a battery of psychometric tests called PHES (Psycometric Hepatic Encephalopathy Score). It is known that one of the main factors contributing to the development of MHE are hyperammonia and inflammation. The main objective of this thesis is use psychometric tests that allow a more sensible study of each specific neurological disorder that PHES and a study on the presence of oxidative/nitrosative stress in MHE and study involvement of this and inflammation in cognitive impairment. This has been evaluated different cognitive disorders (selective attention, selective attention/sustained, working memory, mental processing speed, concentration) and motor (bimanual and visuomotor coordination) through specific tests for each of these alterations and different blood parameters indicators of oxidative stress and inflammation, correlated with each other in order to determine the possible involvement of oxidative stress and inflammation in cognitive impairment in minimal hepatic encephalopathy.