საკვანძო სიტყვები
cognitive impairment
liver–brain axis
neuroinflammation
hepatic fibrosis
როგორ უნდა ციტირება
ანოტაცია
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a condition that impacts about 25–30% of adults worldwide and is now known to be a multisystem disorder with extrahepatic implications. Of these, cognitive impairment has become a clinically relevant but poorly described symptom. This narrative review aims to summarize the existing evidence on the shared pathophysiological mechanisms between MASLD and cognitive decline and their clinical implications. A systematic search of PubMed, Scopus, and the Cochrane Library was performed for peer-reviewed English-language publications in adults with objectively measured hepatic and cognitive outcomes. Several interconnected pathways were identified: insulin resistance affecting cerebral glucose metabolism and synaptic plasticity; chronic systemic and neuroinflammation affecting blood–brain barrier integrity; gut-liver-brain axis dysbiosis leading to endotoxemia and neuroinflammation; oxidative stress and mitochondrial dysfunction leading to neuronal injury; ceramide-mediated dyslipidemia leading to hepatic lipotoxicity and neurodegeneration; and cerebrovascular pathology resulting from endothelial dysfunction and small vessel disease. The severity-dependent relationship was confirmed by the fact that hepatic fibrosis stage, not just simple steatosis, was the more consistent predictor of cognitive risk and Alzheimer-related neuropathological burden. Cardiometabolic comorbidities such as type 2 diabetes, visceral adiposity, and obstructive sleep apnea are mediators and confounders, making causal inference difficult. Lifestyle modification, GLP-1 receptor agonists, and SGLT2 inhibitors have promising hepatic and potential neuroprotective effects, but there is a lack of randomized trial evidence for cognitive endpoints. The results of these studies collectively suggest that the liver–brain axis is a clinically relevant and under-explored therapeutic target and warrant further longitudinal studies and validated cognitive screening tools in high-risk MASLD populations.
წყაროები
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