A Potential Link between Psychoneurological Impairment and Metabolic Stressors: Implications for Metabolic Encephalopathy

Metabolic derangement is considered as a key underlying cause and contributor of metabolic encephalopathy, which is featured by cognitive decline, psychiatric symptoms, and severe coma. Clinical and preclinical studies have demonstrated that malnutrition, electrolyte derangements, toxic agents, and organ failure lead to metabolic disturbances including hyper/hypoglycaemia, hyperammonaemia, vitamin deficiency, hyper/hypokalaemia, hyper/hyponatraemia, and hyper/hypoferraemia. These metabolic stressors result in cognitive impairment and changed mental health. Because metabolic imbalance is often attributed to abnormalities in multiple factors rather than one factor, its distinction and management are critical. In cases of severe metabolic imbalances, it is recommended to identify such abnormalities using multiple strategies. Given that impaired brain function is difficult to recover, long-term dietary regulation and proper management are required by considering underlying diseases or conditions. Hence, by exploring the connections between metabolic imbalances (e.g., glucose, ammonia, indoxyl sulfate, electrolyte ions, and vitamins), and cognitive and mental health, this review provides evidence that emphasises the critical importance of management of metabolic health. Comprehending psychoneurological impairment caused by metabolic disturbances highlights the potential overlap with cognitive/mental symptoms of underlying conditions. Therefore, identifying the key pathological mechanisms of metabolic stress-induced psychoneurological impairment provides valuable insignts into the development of effective management and therapeutic approaches.