Enhanced liver fibrosis score is associated with cognitive performance during an 11-year follow-up period.
10 affiliations
- 1Department of Internal Medicine, University of Turku, Turku, Finland.
- 2Finnish Institute for Health and Welfare, Helsinki, Finland.
- 3University of Eastern Finland, Kuopio, Finland.
- 4Institute for Nutrition and Health Research, Helsinki, Finland.
- 5Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
- 6Department of Neurology, Wellbeing Services County of Southwestern Finland, Turku, Finland.
- 7Turku PET Centre, University Hospital of Turku, Turku, Finland.
- 8Turku PET Centre, University of Turku, Turku, Finland.
- 9Institute of Clinical Physiology, National Research Council (CNR), Pisa, Italy.
- 10Department of Geriatrics, Wellbeing Services County of Southwestern Finland, Turku, Finland.
Abstract
Introduction
Metabolic dysfunction-associated steatotic liver disease (MASLD) has been associated with poorer cognitive performance and greater cognitive decline. However, the liver-brain axis and the role of liver health in cognitive decline are still poorly understood. Thus, using both cross-sectional and longitudinal designs, we aimed to study how liver fibrosis score (ELF), an indicator of liver fibrosis, is associated with cognitive performance.Methods
This study was based on the Health 2000 Survey and its follow-up, the Health 2011 survey, which collected data from a nationally representative sample of the Finnish adult population. At baseline, verbal fluency, wordlist learning, delayed wordlist recall, and simple and multiple-choice reaction time tests were conducted. At follow-up, all tests except the reaction time tests were repeated. A global z-score was derived from the individual cognitive domains. Multivariable regression analysis was performed to study the association between ELF and cognitive performance while adjusting for demographic, metabolic, and cardiovascular covariates.Results
Cross-sectionally (n=5115; mean age 53.2 y; 58.6% women), high ELF was associated with poorer global cognition and slower simple and multiple-choice reaction times compared with low ELF. High ELF was also associated with worse global cognition and performance in the wordlist learning test, both cross-sectionally and longitudinally (n=2490; mean age 48.7 y at baseline; 58.0% women).Discussion
High ELF, an indicator of liver fibrosis, was associated with poorer global cognition both cross-sectionally and longitudinally. Worse performance was observed in cognitive domains that reflect poorer processing speed and executive function, verbal learning, attention, and working memory. These results imply that liver fibrosis could represent an early modifiable marker of cognitive vulnerability.
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BibTeX
@article{vataja2026enhanced,
title = {{Enhanced liver fibrosis score is associated with cognitive performance during an 11-year follow-up period.}},
author = {Emilia Vataja and Katri Sääksjärvi and Jenni Lehtisalo and Iris Erlund and Terhi Vihervaara and Tiia Ngandu and Seppo Koskinen and Fredrik Åberg and Antti Jula and Juha Rinne and Miikka-Juhani Honka and Laura Ekblad},
journal = {Hepatology communications},
year = {2026},
month = oct,
doi = {10.1097/hc9.0000000000001059},
url = {https://europepmc.org/article/MED/42900153},
note = {CC BY},
}
RIS
TY - JOUR
TI - Enhanced liver fibrosis score is associated with cognitive performance during an 11-year follow-up period.
AU - Emilia Vataja
AU - Katri Sääksjärvi
AU - Jenni Lehtisalo
AU - Iris Erlund
AU - Terhi Vihervaara
AU - Tiia Ngandu
AU - Seppo Koskinen
AU - Fredrik Åberg
AU - Antti Jula
AU - Juha Rinne
AU - Miikka-Juhani Honka
AU - Laura Ekblad
PY - 2026
DA - 2026/10/19
JO - Hepatology communications
DO - 10.1097/hc9.0000000000001059
UR - https://europepmc.org/article/MED/42900153
AB - Introduction Metabolic dysfunction-associated steatotic liver disease (MASLD) has been associated with poorer cognitive performance and greater cognitive decline. However, the liver-brain axis and the role of liver health in cognitive decline are still poorly understood. Thus, using both cross-sectional and longitudinal designs, we aimed to study how liver fibrosis score (ELF), an indicator of liver fibrosis, is associated with cognitive performance.Methods This study was based on the Health 2000 Survey and its follow-up, the Health 2011 survey, which collected data from a nationally representative sample of the Finnish adult population. At baseline, verbal fluency, wordlist learning, delayed wordlist recall, and simple and multiple-choice reaction time tests were conducted. At follow-up, all tests except the reaction time tests were repeated. A global z-score was derived from the individual cognitive domains. Multivariable regression analysis was performed to study the association between ELF and cognitive performance while adjusting for demographic, metabolic, and cardiovascular covariates.Results Cross-sectionally (n=5115; mean age 53.2 y; 58.6% women), high ELF was associated with poorer global cognition and slower simple and multiple-choice reaction times compared with low ELF. High ELF was also associated with worse global cognition and performance in the wordlist learning test, both cross-sectionally and longitudinally (n=2490; mean age 48.7 y at baseline; 58.0% women).Discussion High ELF, an indicator of liver fibrosis, was associated with poorer global cognition both cross-sectionally and longitudinally. Worse performance was observed in cognitive domains that reflect poorer processing speed and executive function, verbal learning, attention, and working memory. These results imply that liver fibrosis could represent an early modifiable marker of cognitive vulnerability.
SN - 2471-254X
ER -