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
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".