*Purpose: Cognitive impairment (CI) is highly prevalent in liver cirrhosis. Improvement after liver transplant (LT) varies among patients, diminishing the benefits of LT for some. We aimed to assess pre-to-post-LT cognitive changes one month after LT using the NIH Toolbox (NIHTB), a standardized, quantitative, and validated cognition assessment tool that can be administered on an iPad in under 15 minutes.

*Methods: Baseline cognitive function was assessed using the NIHTB in 130 LT waitlist registrants randomly selected from the Northwestern Medicine Pre-LT Clinic (age 58±10; 64% men; MELD-Na 14±5.3; etiology 35% alcoholic, 22% nonalcoholic steatohepatitis, 29% viral hepatitis, 14% others). Of those, 11 patients (age at transplant 59±8; 82% men; MELD-Na 16±5.6; etiology 27% alcoholic, 36% viral hepatitis, 36% others) underwent LT within 12 months of baseline assessment and a repeat NIHTB assessment one month after LT.

*Results: Cognitive function was worse in LT waitlist registrants compared to demographic-matched U.S. population (40.2±8.6 vs. 50±10, p<0.001), consistent with prior studies that used traditional neuropsychological testing methods. Cognitive function improved one month after LT compared to baseline (40.1±9.0 vs. 43.3±10.7, p=0.016).

*Conclusions: NIHTB is a sensitive and practical cognitive assessment tool to detect early cognitive changes after LT. An in-progress longitudinal study with a larger sample size will help confirm these preliminary findings and identify predictors of individual cognitive changes.

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