Neuropsychological Assessment Informed Intervention during Liver Transplantation Evaluation: A Case Report Journal of Psychiatry & Mental Disorders Price JS, Zanowski SC and Hong JC. Neuropsychological Assessment Informed Intervention during Liver Transplantation Evaluation: A Case Report. J Psychiatry Mental Disord. 2021; 6(5): 1055.
Date
12/30/2021Abstract
Abstract
Aims: Pre-transplant non-adherence is associated with poorer outcomes
post-transplantation. Comorbid cognitive deficits can negatively impact
adherence, limiting access to transplant. We report use of an abbreviated
neuropsychological assessment to inform treatment planning for a critically-ill
patient with liver failure due to alcohol cirrhosis in need of liver transplantation.
Methods: The patient was a 25-year-old Hispanic male with limited
education, history of daily alcohol use and 6 months abstinence. While inpatient
and in transplant evaluation, he demonstrated non-adherent behaviors and poor
insight into health consequences. A head CT was unremarkable.
Results: Neuropsychological testing results estimated borderline to
impaired intellectual functioning. Simple attention and story memory were low
average whereas other cognitive domains were borderline to impaired. There
was no memory degradation over time. Etiological considerations included
premorbid intellectual dysfunction, longstanding severe alcohol use disorder,
and mild hepatic encephalopathy in the setting of liver failure.
Discussion: Deficits in higher order cognitive processing were consistent
with observed challenges with impulse control and adherence. Intervention
focused on relative strengths in simple attention and memory for structured
material. The patient demonstrated improved adherence but died while awaiting
transplant. This case highlights the utility of neuropsychological assessment
and focused intervention in optimizing transplant candidacy.
