Cognitive Function Assessment Using the Stroop Test: Exploring the Broader Therapeutic Potential of L-Ornithine L-Aspartate (LOLA, Hepa-Merz), a Hepatic Encephalopathy Medication

Petar, Avramovski and Emilija, Parisko and Maja, Avramovska and Pece, Stefanovski and Zorica, Nikleski and Kosta, Sotiroski and Zdraveski, Dejan Cognitive Function Assessment Using the Stroop Test: Exploring the Broader Therapeutic Potential of L-Ornithine L-Aspartate (LOLA, Hepa-Merz), a Hepatic Encephalopathy Medication. EC Pulmonology and Respiratory Medicine. ISSN 2591-7317

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Abstract

Abstract
Background: L-Ornithine L-Aspartate (LOLA), known commercially as Hepa-Merz, is widely used in the treatment of hepatic
encephalopathy (HE) due to its ability to facilitate ammonia clearance via both urea and glutamine pathways. In addition to its
established role in HE, emerging evidence suggests LOLA may aid liver regeneration, support mitochondrial function, and reduce
oxidative stress. This study investigates LOLA’s potential impact on cognitive performance in individuals with minimal hepatic
encephalopathy (MHE), utilizing the Stroop Test as a neuropsychological evaluation tool and correlating findings with serum
ammonia concentrations.
Methods: Sixty-five patients diagnosed with MHE underwent cognitive evaluation before and after administration of LOLA. Ammonia
levels were quantified both pre- and post-intervention. The Stroop Test, including Stroop Word (SW), Stroop Color (SC), Stroop ColorWord (SCW), and the Total Stroop Test (TST), was used to assess changes in cognitive speed and accuracy. Data were analyzed using
unpaired t-tests to evaluate the significance of observed changes.
Results: Post-treatment results showed a significant decrease in blood ammonia levels (from 123.2 ± 27.1 µmol/L to 112.7 ± 24.1
µmol/L, p < 0.05). All Stroop Test components demonstrated marked improvement, with faster TST indicating better cognitive
processing. Moreover, patients with initially elevated ammonia levels tended to perform worse on cognitive testing, reinforcing the
link between hyperammonemia and cognitive dysfunction.
Conclusion: Hepa-Merz demonstrates efficacy in reducing systemic ammonia and enhancing cognitive function in MHE patients.
The Stroop Test proves to be a sensitive and practical measure for detecting neurocognitive changes and treatment effects. These
findings support further exploration of LOLA’s (Hepa-Merz) benefits beyond traditional HE management, particularly in preserving
or improving brain function

Item Type:	Article
Subjects:	Scientific Fields (Frascati) > Medical and Health Sciences > Basic medicine Scientific Fields (Frascati) > Medical and Health Sciences > Clinical medicine
Divisions:	Higher Medical School
Depositing User:	Mr Dimitar Risteski
Date Deposited:	31 Oct 2025 12:00
Last Modified:	31 Oct 2025 12:00
URI:	https://eprints.uklo.edu.mk/id/eprint/11142

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