Lucas IC, Filgueira NA, Domingues AL, Lopes EP, Albuquerque IKP, Barbosa BJAP. Multidimensional cognitive impairment in hepatosplenic schistosomiasis: A cross-sectional study. World J Psychiatry 2026; 16(4): 115373 [DOI: 10.5498/wjp.v16.i4.115373]
Corresponding Author of This Article
Iris Campos Lucas, PhD, Professor, Programa de Pós-Graduação em Medicina Tropical, Centro de Ciências Médicas, Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, No. 1235 Cidade Universitária, Recife 50670-901, Pernambuco, Brazil. iriscamposlucas@gmail.com
Research Domain of This Article
Neurosciences
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Iris Campos Lucas, Norma Arteiro Filgueira, Ana Lucia Domingues, Edmundo Pessoa Lopes, Ianca Karine Prudencio Albuquerque, Programa de Pós-Graduação em Medicina Tropical, Centro de Ciências Médicas, Universidade Federal de Pernambuco, Recife 50670-901, Pernambuco, Brazil
Iris Campos Lucas, Norma Arteiro Filgueira, Ana Lucia Domingues, Edmundo Pessoa Lopes, Serviço de Gastroenterologia, Hospital das Clínicas/EBSERH, Universidade Federal de Pernambuco, Recife 50670-901, Pernambuco, B, Recife 50670-901, Pernambuco, Brazil
Breno José Alencar Pires Barbosa, Área de Neuropsiquiatria, Centro de Ciências Médicas, Universidade Federal de Pernambuco, Recife 50670-901, Pernambuco, Brazil
Author contributions: Lucas IC, Filgueira NA, and Lopes EP conceptualized and refined the study design; Lucas IC collected the clinical data, performed the psychometric tests, and drafted the manuscript; Domingues AL conducted the ultrasound examinations; Lucas IC and Albuquerque IKP analyzed the data and performed the statistical analyses; Filgueira NA, Domingues AL, Lopes EP, and Barbosa BJAP critically reviewed and revised the manuscript. And all authors read and approved the definitive version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Hospital das Clínicas, Universidade Federal de Pernambuco (No. 4.958.385).
Informed consent statement: Prior to inclusion, written informed consent was secured from every participant.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets supporting the conclusions of this article are available from the corresponding author upon reasonable request. Data are not publicly available to protect participants’ privacy.
Corresponding author: Iris Campos Lucas, PhD, Professor, Programa de Pós-Graduação em Medicina Tropical, Centro de Ciências Médicas, Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, No. 1235 Cidade Universitária, Recife 50670-901, Pernambuco, Brazil. iriscamposlucas@gmail.com
Received: October 16, 2025 Revised: November 14, 2025 Accepted: December 25, 2025 Published online: April 19, 2026 Processing time: 166 Days and 5.5 Hours
Abstract
BACKGROUND
Cognitive impairment is a well-recognized complication of liver diseases, primarily associated with cirrhotic portal hypertension. However, its spectrum and prevalence in patients with non-cirrhotic portal hypertension due to hepatosplenic schistosomiasis (HSS) remain poorly characterized, particularly regarding domains beyond minimal hepatic encephalopathy (MHE).
AIM
To characterize cognitive performance and determine the prevalence of deficits across multiple domains in a large cohort of patients with HSS.
METHODS
This cross-sectional study enrolled 200 adult patients with confirmed HSS at a Brazilian reference center. Participants underwent a comprehensive psychometric battery, including Mini-Mental State Examination for global cognition, the animal verbal fluency test for MHE and semantic fluency, the clock drawing test for visuospatial and executive functions, the digit span test (DST) for attention and working memory, and the Go/no-Go test for inhibitory control. Impairment was defined using established, education-adjusted cut-offs.
RESULTS
The cohort had a mean age of 56.4 years and limited formal education (mean 4.9 years). Global cognitive impairment, defined as a Mini-Mental Examination Score < 25, was identified in 36.5% of patients. Domain-specific assessment revealed a high prevalence of deficits in visuospatial and planning abilities, affecting 67% of patients according to the clock drawing test. Working memory impairments were detected in 53.5% (forward DST) and 83% (backward DST) of participants. Abnormal performance on the Go/No-Go test, indicating deficits in inhibitory control, was observed in 66.5% of the sample. The animal verbal fluency test identified MHE in 24.5% of participants, a finding significantly associated with lower educational attainment (P < 0.01). Notably, while MHE was strongly linked to the presence of portosystemic shunts (P = 0.0018), deficits in other cognitive domains were highly prevalent regardless of portosystemic shunts status.
CONCLUSION
Cognitive impairment in HSS is highly prevalent and encompasses a broad range of deficits, extending well beyond MHE. These findings support the implementation of routine, multidimensional cognitive screening in standard management of HSS patients.
Core Tip: Cognitive impairment in hepatosplenic schistosomiasis goes well beyond minimal hepatic encephalopathy, affecting areas such as visuospatial abilities, working memory, and inhibitory control. Our study, using a brief, culturally adapted assessment battery, found over two-thirds of patients impaired in these domains, often independent of portosystemic shunt presence. These findings call for a paradigm shift from solely minimal hepatic encephalopathy-focused screening to comprehensive, multidimensional cognitive assessment in hepatosplenic schistosomiasis, enabling earlier detection and a more holistic approach to management in endemic, low-resource settings.
