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Cognitive impairment in non-cirrhotic chronic liver disease is unrelated to liver disease severity but associated with ineffective baroreflex function
  1. James Frith1,2,
  2. Gulnar Fattakhova1,2,
  3. David E J Jones1,3,
  4. Elsbeth Henderson1,
  5. Katharine Wilton1,
  6. Christopher P Day1,3,
  7. Julia L Newton1,2
  1. 1UK NIHR Biomedical Research Centre in Ageing—Liver Theme, Newcastle University, Newcastle, UK
  2. 2Institute of Ageing and Health, Newcastle University, Newcastle, UK
  3. 3Institute of Cellular Medicine, Newcastle University, Newcastle, UK
  1. Correspondence to Professor Julia L Newton, UK NIHR Biomedical Research Centre in Ageing, Institute for Ageing and Health, Medical School, Newcastle University, Newcastle NE2 4HH, UK; julia.newton{at}

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Research letter

We read with interest the commentary by Bercik1 emphasising the influence that gut intestinal microflora may have on cognitive function—a model with clear therapeutic implications. We would like to propose, however, that a third party—the presence of autonomic nervous system dysfunction—complicates the relationship between cognitive impairment and gut microflora.

In a number of diseases, autonomic dysfunction has been associated with cognitive impairment,2 3 and its presence is associated with impaired gastrointestinal motility, a risk factor for changes in bacterial colonisation. Autonomic dysfunction is a common problem in patients with chronic liver disease (CLD)4—the group of patients highlighted in the commentary as having obvious cognitive problems, as benefiting from treatment aimed at modifying the …

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