A193 COGNITIVE DYSFUNCTION IS PRESENT IN HALF OF STABLE OUTPATIENTS WITH CIRRHOSIS AND IS STRONGLY ASSOCIATED WITH THE POTENTIALLY MODIFICABLE FACTORS, DEPRESSION AND LOW MUSCLE STRENGTH

Impaired cognitive function is a key prognostic factor in patients with cirrhosis. This is often, but not always, attributable to hepatic encephalopathy (HE). The Montreal Cognitive assessment (MOCA) is a sensitive measure of mild cognitive impairment, yet has been sparingly reported in the literature in cirrhotic populations. In a cohort of stable cirrhosis outpatients without overt HE, we aimed to: i) characterize baseline MOCA scores, ii) determine the domains of MOCA that are most commonly affected and iii) determine the predictors of a low MOCA score (<26). Consecutive adults with cirrhosis assessed prospectively in one of two Edmonton cirrhosis clinics between May 2013 and June 2016 were screened for enrolment. Exclusion criteria included active malignancy, dementia, HCC outside of Alberta liver transplant criteria, end-stage renal disease and overt HE (as defined by lack of orientation (person, place, time) or asterixis). Multivariable logistic regression analysis was used to determine independent predictors of a MOCA <26. Fifty-three patients were excluded because they were disoriented to person, place or time. Of 390 included patients, the mean age was 55.6 ± 9.8, 62% were male and the etiology of cirrhosis was alcohol or hepatitis C in 54%. Thirty-two percent scored positive for depression. Forty-one percent had an abnormal handgrip as defined by BMI and sex cut-offs. The mean MOCA score was 25.2 ± 3.2 and 45% had a score of <26. Abnormalities were most commonly seen in the following MOCA subdomains – delayed recall (81%), visuospatial/executive (70%), attention (48%) and language (46%) and least commonly seen in abstraction (19%) and naming (7%). Depression was the only independent predictor of a MOCA <26, with increasing age trending to significance (Table 1). In a large cohort of stable cirrhosis outpatients, 45% of them have MOCA scores below the accepted lower limits of normal. Depression and low muscle strength are associated with lower cognitive function scores. These potentially modifiable variable needs to be screened for and treated to determine if they may positively impact cognitive function. Ongoing work will associate MOCA total scores and subdomains with clinical outcomes including unplanned hospitalization, death and HE related hospitalizations. None

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