Introduction
Chronic pancreatitis (CP) is a chronic inflammatory disease of the pancreas that can lead to a wide range of complications. Previous studies have reported that CP may also be associated with subclinical cognitive impairment (SCI).
Aims & Methods
The aim of this study was to prospectively determine the prevalence, characteristics and causes of SCI and to assess its impact on quality of life and physical performance in patients with CP.
Patients with fulfilled criteria in imaging for CP were prospectively enrolled. Patients with any form of overt metabolic (e.g. hepatic, uremic) encephalopathy, neurodegenerative disorders (e.g. dementia, Parkinson’s disease), decompensated cirrhosis or sepsis were excluded. All patients underwent psychometric testing (Psychometric Hepatic Encephalopathy Score (PHES) test battery, animal naming test (ANT)), assessment of health-related quality of life (QoL; EORTC C30 PAN28), such as mobility and strength (timed “up-and-go” test (TUG), chair rising test (CRT), tandem gait test, hand grip strength). SCI was diagnosed when at least one test of the PHES was pathological. Possible risk factors described previously (e.g. malnutrition, pancreatic exocrine insufficiency (PEI), pain, alcohol abuse, sleep disturbance, opioid use) were prospectively assessed.
Results
Seventy-one patients with a median age of 58 years were enrolled, and 23% were female. According to the TIGAR-O classification, the etiology was toxic (alcohol/ smoking) in most (49%) of the cases. 69% had a history of pain due to CP and 37% reported suffering from sleep disturbances.
SCI was prevalent in 41% of the patients, while 25% had only one and 16% had two or more pathological tests. Interestingly, only 3 patients showed a pathological ANT. Patients with SCI had lower overall QoL scores (p=0.048). Regarding QoL, it was mainly physical functionality that was impaired (p<0.001). Consistent with these data, patients with SCI took significantly longer to complete the TUG (p=0.008) and had more frequent pathologic CRT (p=0.004). However, while approximately 16% of the patients reported injury from a fall in the past 12 months, there was no significant association with SCI in the present study.
In addition, surrogate parameters for malnutrition, such as serum prealbumin (p=0.01), magnesium (p<0.001) and iron (p=0.02) were decreased in patients with SCI.
Among all possible risk factors analyzed, only a history of alcohol abuse was significantly associated with SCI in univariable analysis. In addition, alcohol abuse was also an independent risk factor of SCI (odds ratio (OR) 3.46; p=0.02) in a multivariable regression model together with the variables age, gender, education and cirrhosis.
Despite SCI affecting global QoL, sleep disturbance appeared to be the strongest variable independently associated with impaired QoL in multivariable analysis (OR 9.9; p=0.001).
Conclusion
We show that subclinical cognitive impairment (SCI) is prevalent in patients with CP and can impact quality of life and physical performance. Alcohol abuse was found to be a significant risk factor for SCI, while sleep disturbance was the strongest variable affecting global quality of life. These findings suggest the need for addressing modifiable risk factors in CP patients to improve outcomes.
