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Med."],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>End-stage liver disease (ESLD) is associated with cognitive impairment ranging from subtle alterations in attention to overt hepatic encephalopathy that resolves after transplant. Natural language processing (NLP) may provide a useful method to assess cognitive status in this population. We identified 81 liver transplant recipients with ESLD (4\/2013\u20132\/2018) who sent at least one patient-to-provider electronic message pre-transplant and post-transplant, and matched them 1:1 to \u201chealthy\u201d controls\u2014who had similar disease, but had not been evaluated for liver transplant\u2014by age, gender, race\/ethnicity, and liver disease. Messages written by patients pre-transplant and post-transplant and controls was compared across 19 NLP measures using paired Wilcoxon signed-rank tests. While there was no difference overall in word length, patients with Model for End-Stage Liver Disease Score (MELD)\u2009\u2265\u200930 (<jats:italic>n<\/jats:italic>\u2009=\u200931) had decreased word length in pre-transplant messages (3.95 [interquartile range (IQR) 3.79, 4.14]) compared to post-transplant (4.13 [3.96, 4.28], <jats:italic>p<\/jats:italic>\u2009=\u20090.01) and controls (4.2 [4.0, 4.4], <jats:italic>p<\/jats:italic>\u2009=\u20090.01); there was no difference between post-transplant and controls (<jats:italic>p<\/jats:italic>\u2009=\u20090.4). Patients with MELD\u2009\u2265\u200930 had fewer 6+ letter words in pre-transplant messages (19.5% [16.4, 25.9] compared to post-transplant (23.4% [20.0, 26.7] <jats:italic>p<\/jats:italic>\u2009=\u20090.02) and controls (25.0% [19.2, 29.4]; <jats:italic>p<\/jats:italic>\u2009=\u20090.01). Overall, patients had increased sentence length pre-transplant (12.0 [9.8, 13.7]) compared to post-transplant (11.0 [9.2, 13.3]; <jats:italic>p<\/jats:italic>\u2009=\u20090.046); the same was seen for MELD\u2009\u2265\u200930 (12.3 [9.8, 13.7] pre-transplant vs. 10.8 [9.6, 13.0] post-transplant; <jats:italic>p<\/jats:italic>\u2009=\u20090.050). Application of NLP to patient-generated messages identified language differences\u2014longer sentences with shorter words\u2014that resolved after transplant. NLP may provide opportunities to detect cognitive impairment in ESLD.<\/jats:p>","DOI":"10.1038\/s41746-019-0179-9","type":"journal-article","created":{"date-parts":[[2019,11,4]],"date-time":"2019-11-04T11:03:13Z","timestamp":1572865393000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Language impairment in adults with end-stage liver disease: application of natural language processing towards patient-generated health records"],"prefix":"10.1038","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6509-8393","authenticated-orcid":false,"given":"Lindsay K.","family":"Dickerson","sequence":"first","affiliation":[]},{"given":"Masoud","family":"Rouhizadeh","sequence":"additional","affiliation":[]},{"given":"Yelena","family":"Korotkaya","sequence":"additional","affiliation":[]},{"given":"Mary Grace","family":"Bowring","sequence":"additional","affiliation":[]},{"given":"Allan B.","family":"Massie","sequence":"additional","affiliation":[]},{"given":"Mara A.","family":"McAdams-Demarco","sequence":"additional","affiliation":[]},{"given":"Dorry L.","family":"Segev","sequence":"additional","affiliation":[]},{"given":"Alicia","family":"Cannon","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2458-7160","authenticated-orcid":false,"given":"Anthony L.","family":"Guerrerio","sequence":"additional","affiliation":[]},{"given":"Po-Hung","family":"Chen","sequence":"additional","affiliation":[]},{"given":"Benjamin N.","family":"Philosophe","sequence":"additional","affiliation":[]},{"given":"Douglas B.","family":"Mogul","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2019,11,4]]},"reference":[{"key":"179_CR1","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1002\/hep.27210","volume":"60","author":"H Vilstrup","year":"2014","unstructured":"Vilstrup, H. et al. 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