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The World Health Organization (WHO) estimates 171
million individuals worldwide are infected with hepatitis C virus (HCV). However, the prevalence of HCV infection varies throughout the world.
Egypt had the highest number of reported infections, largely attributed to the use of contaminated parenteral antischistosomal therapy. This led to a mean prevalence of HCV antibodies in persons in Egypt of 22 %.
Chronic infection with HCV is one of the most important causes of chronic liver disease which can progress to cirrhosis and hepatocellular carcinoma (HCC).
The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) defines Executive functions as the ability to plan, initiate, sequence, monitor, and inhibit complex goal-directed behaviour.
Executive dysfunction results from disruption of the neural circuits maintaining executive function may lead to apathy and subsequent functional impairment, resistance to care, and impaired decision-making capacity.Executive dysfunction has long been recognized as a consequence of chronic liver disease. However, until recently, cognitive impairment was considered a complication of cirrhosis associated with hepatic encephalopathy.
However, there has been growing evidence that the alterations in cerebral function in patients with chronic HCV infection may appear long before the development of severe liver cirrhosis.
This study aimed at investigating the possible existence of alterations in the executive functions of HCV patients without liver cirrhosis.
It is a case control study carried out on 111 elderly patients divided into 2 groups, group A consisted of 51 patients with chronic infection with HCV (cases) and group B:consisted of 51 healthy individuals not infected with HCV (control) recruited from geriatric department ,internal medicine department and outpatient clinics in Ain Shams university hospital. All participants were subjected to:
1- Comprehensive geriatric assessment by:
Complete history and physical examination.
Assessment of depression by Geriatric Depression Scale (GDS). Assessment of mental state by Mini Mental Status Examination (MMSE).
Evaluation of the Executive functions by using 5
neuropsychological tests. These tests are: Block design, Animal verbal fluency, Clock drawing, The Executive Interview 25 (EXIT 25) and digit span.
2- Abdominal ultrasound to exclude liver cirrhosis.
3- Diagnosis of HCV by HCV antibody testing
Exclusion was done for those who refused to participate, patients with liver cirrhosis, HBV, HIV infection, Clinical signs of liver cell failure, patients receiving antiviral therapy, patients with dementia, delirium or depression and patients with other comorbidities affecting executive functions.
The study showed that chronic HCV infection is accompanied by impaired executive functions even in the absence of liver cirrhosis suggesting direct action of the hepatitis C virus on the frontal lobe.
The study showed that there is a significant difference between cases and controls regarding Exit 25 and digit span backwards tests scores indicating affection of the phonological loop component of working memory among HCV positive patients, but there was no significant difference between cases and controls regarding clock drawing test and block design test scores indicating intact visuospatial component of working memory.
Also there was no significant difference between cases and controls regarding Animal verbal fluency test indicating that HCV infection have no effect on Cognitive flexibility.