Cortical networks are disturbed in people with cirrhosis even in the absence of neuropsychometric impairment

Abstract Objective Hepatic encephalopathy is a common complication of cirrhosis; it is characterised by neuropsychometric/neurophysiological abnormalities. Its pathophysiology is complex but glial neuronal communication is likely to be disrupted and to impact on oscillatory networks and cortical connectivity. The aim of this study was to use multichannel electroencephalography (EEG) to investigate functional connectivity, as a surrogate for cortical networks, in patients with cirrhosis. Methods Resting EEGs were recorded in 98 healthy controls and in 264 patients with cirrhosis characterised psychometrically using the Psychometric Hepatic Encephalopathy Score (PHES). Functional connectivity was calculated using the phase-lag index with stratification into standard EEG frequency bands. The findings were validated in a further cohort of 39 healthy controls and 106 patients with cirrhosis. Results Widespread disruption in functional connectivity was observed in the patients compared with the controls; connectivity was increased in the theta (4–8 Hz) band and decreased in the delta (1–3.5 Hz), alpha (8.5–13 Hz) and beta (13.5–26.5 Hz) bands. Changes were apparent even in patients who were psychometrically unimpaired compared with healthy controls viz mean ± SEM theta 0.107 ± 0.001 vs . 0.103 ± 0.002 (p  vs. 0.154 ± 0.003 (p  Conclusions Cortical networks are disturbed in patients with cirrhosis even in the absence of psychometric impairment. Significance These findings will facilitate further exploration of the pathophysiology of this condition and provide a robust means for assessing treatment effects in research settings.