Resting-State fMRI Global Small-World Network as a Mediator Between Glymphatic System and Cognitive Function in Minimal Hepatic Encephalopathy

Motivation: Minimal hepatic encephalopathy (MHE) adversely affects quality of life and cognition in cirrhotic patients, yet its pathogenesis is unclear. Investigating glymphatic dysfunction and brain network inefficiency may reveal new intervention points. Goal(s): This study examines how glymphatic function and brain network efficiency contribute to cognitive impairment in MHE. Approach: Sixty-seven patients with decompensated cirrhosis underwent diffusion tensor imaging to assess glymphatic function and resting-state fMRI to evaluate brain network efficiency. Results: MHE patients exhibited reduced glymphatic activity and impaired network efficiency, with mediation analysis showing that the gamma index partially mediated the impact of glymphatic dysfunction on cognitive decline. Impact: The discovery of reduced glymphatic system activity and diminished brain network efficiency offers valuable insights into potential mechanisms underlying MHE. These findings may aid in developing targeted therapies for MHE, ultimately enhancing patient care and outcomes.