The Effect of Mental Health, Neurological Disease, and Liver Disease on Quality of Life in Patients With Wilson Disease

• Published in: Journal of the Academy of Consultation-Liaison Psychiatry 2021-09, Vol.62 (5), p.528-537
• Main Authors: Camarata, Michelle A., Ala, Aftab, Coskun, Ayse K., Deng, Yanhong, Gonzalez-Peralta, Regino P., Maciejewski, Kaitlin R., Patel, Amar, Rubman, Susan, To, Uyen, Tomlin, Ricarda, Schilsky, Michael L., Zimbrean, Paula C.
• Format: Article
• Language: English
• Subjects: copper; Depressive Disorder, Major; End Stage Liver Disease; genetic; Hepatolenticular Degeneration; Humans; Mental Health; Quality of Life; rare; screening; Severity of Illness Index
• ISSN: 2667-2960; 2667-2979; 2667-2960
• DOI: 10.1016/j.jaclp.2021.04.004

Wilson disease (WD) is a chronic disorder of copper metabolism which may affect patient's quality of life (QOL). Our aim was to assess the relationship between mental QOL (M-QOL) and physical QOL (P-QOL) and severity of the liver, neurological disease and mental health in patients with WD. At enrollment into our multisite international WD registry, adults (n = 62) were administered examinations assessing QOL (Short-Form 12-Item Health Survey), cognition, and mood. Patients also underwent hepatology and neurological assessments. Patients had lower M-QOL than P-QOL scores, P = 0.0006. Patients with major depressive disorder (n = 22) had worse M-QOL scores, P = 0.0017 but not P-QOL. We found no association with impaired cognition (n = 37) and QOL. The P-QOL scores have a moderate negative association with neurological disease severity based on the Unified Wilson Disease Rating Scale score (total [r = -0.38, P < 0.003], part 2 [r = -0.50, P < 0.0001], and part 3 [r = -0.37, P = 0.004]). M-QOL was not associated with Unified Wilson Disease Rating Scale scores. Worse P-QOL, but not M-QOL, was found in higher cirrhosis severity indicated by Child-Pugh (r = -0.80, P = 0.002) and Model for End Stage Liver Disease scores (r = -0.64, P = 0.03). M-QOL was associated with depression but not cognitive impairment, neurological disease, or liver disease severity, suggesting that mental health issues may affect overall QOL independent of the degree of liver or neurological disease. P-QOL was affected by the severity of neurological and liver disease but not mental health but also contributes to overall QOL in WD. An appreciation of the range of problems that affect QOL in adults with WD will help health care providers address issues that could improve overall well-being. The Short-Form 12-Item Health Survey may provide a useful instrument for QOL surveillance in WD.