Inhibitory Control Test for the Diagnosis of Minimal Hepatic Encephalopathy (original) (raw)
Related papers
Clinical and Experimental Hepatology
Introduction: Minimal hepatic encephalopathy (MHE) represents one of the most overlooked complications of liver cirrhosis. Aim of the study: To compare the utility and efficacy of different MHE diagnostic modalities. Material and methods: This case-control study was conducted on hepatitis C virus (HCV)-related compensated cirrhotic patients. The Psychometric Hepatic Encephalopathy Score (PHES) was used to assign patients to MHE and controls. All patients were subjected to plasma ammonia, serum 3-nitrotyrosine (3-NT), critical flicker frequency (CFF), and the modified inhibitory control test (ICT). Results: CFF was significantly lower in the control group (38.5, 40 Hz, p = 0.003). The unweighted lures on ICT were 8.7, 4.9 in MHE and controls (p < 0.001). Moreover, ammonia was higher in the MHE group (89, 61.5 µmol/l, p < 0.001). 3-NT was also higher in the MHE group (31.5, 13.7 nmol/l, p < 0.001) respectively. CFF at cutoff < 39 Hz had sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 57.5%, 77.5%, 71.9% and 64.6%, respectively; in modified ICT, at cutoff > 5 unweighted lures the values were 87.5%, 80%, 81.4% and 86.5%, respectively; in ammonia, at cutoff ≥ 76.45 µmol/l the values were 65%, 72.5%, 70.3% and 67.4%, respectively; for 3-NT at cutoff ≥ 14.15 nmol/l the values were 85%, 82.5%, 82.9% and 84.6%, respectively. The accuracy for MHE diagnosis was 67.5%, 83.3%, 68.8%, 83.8% relying on CFF, 3-NT, ammonia, and ICT respectively. On multivariate analysis, CFF < 39 Hz (OR = 10.2, p = 0.04), modified ICT > 5 unweighted lures (OR = 43.2, p = 0.002), and serum 3-NT levels ≥ 14.15 nmol/l (OR = 50.4, p < 0.001) were independent predictors of MHE. Conclusions: 3-NT and ICT are advantageous to reveal MHE in compensated liver cirrhosis, while CFF can be only used as adjuncts, with humble merits of ammonia.
A Simplified Psychometric Evaluation for the Diagnosis of Minimal Hepatic Encephalopathy
Clinical Gastroenterology and Hepatology, 2011
The psychometric hepatic encephalopathy score (PHES), which includes 5 psychometric tests, is a standard for the diagnosis of minimal hepatic encephalopathy (HE). We investigated whether a simplified PHES (SPHES) is as useful as the whole PHES. METHODS: The PHES was determined for 79 cirrhotic patients (the training group), who were followed up for the development of overt HE. Backward logistic regression was performed by eliminating stepwise variables-removal did not impair regression. A separate series of 65 patients was used as a validation group. RE-SULTS: The PHES was abnormal in 45 patients. The SPHES, determined from the digit symbol, serial dotting, and line tracing tests, did not differ significantly from the full PHES; 24 of the 79 patients developed overt HE. The likelihood of developing overt HE was higher among patients with an abnormal PHES (log-rank P ϭ .003) or SPHES (P ϭ .004). By using Cox regression and model for end-stage liver disease scores to analyze data from patients with previous HE and transjugular intrahepatic portosystemic shunts, PHES (relative risk, 4.16; P ϭ .003) and SPHES (relative risk, 3.70; P ϭ .004) were the only variables associated with the development of overt HE. The accuracy of the SPHES was confirmed in the validation group.
The study of psychometric test for detection and assessment in subclinical hepatic encephalopathy
International Journal of Medical Research and Review
Background: During past two decades, psychometric tests have been used extensively for detection of SHE. However, the results have been variables with different tests. In real practice we require the tests, which can be administered quickly by treating physician with simplicity and with simple instrument or only with a simple form. Objective: (1) To apply a battery of psychometric tests in cases of cirrhosis of liver. (2) To correlate findings of psychometric tests with Child`s index of severity for cirrhosis of liver. Methodology: 25 patients of cirrhosis of liver diagnosed by ultrasonography, biochemical and clinical evidence, admitted in the Medicine ward, will constitute the study group. These patients will undergo a battery of psychometric tests and EEG along with other routine hematological and radiological test. 25 control group with confounding factors as age, sex, education and socioeconomic status. Results: We observed that on WAPIS test cirrhotic performed significantly worse than controls. Mean IQ±SD non-Alcoholic cirrhotic on WAPIS was [67.78±11.29] and Mean IQ±SD of alcoholic cirrhotics was (66.45±9.71). On analysis of data the difference was not significant (p>0.005). Taken together the performance test was abnormal in 14 (56%) cases. Conclusion: We concluded that for quick assessment of mental status and screening for detecting SHE in cases of cirrhosis of liver with portal hypertension, TMT test is useful and for complete assessment of cerebral function derangement WAPIS is most sensitive and complete test.
Assessment of low-grade hepatic encephalopathy: A critical analysis
Journal of Hepatology, 2007
Background/Aims: The value of paper-pencil tests and West-Haven-criteria for assessment of low-grade hepatic encephalopathy under conditions of a randomized, double-blind, placebo-controlled, clinical trial was evaluated in a cohort of 217 cirrhotics.
Assessment of minimal hepatic encephalopathy (with emphasis on computerized psychometric tests)
Clinics in liver disease, 2012
Minimal hepatic encephalopathy (MHE) is associated with a high risk of development of overt hepatic encephalopathy, impaired quality of life, and driving accidents. The detection of MHE requires specialized testing because it cannot, by definition, be diagnosed on standard clinical examination. Psychometric and neurophysiologic techniques are often used to test for MHE. Paper-pencil psychometric batteries and computerized tests have proved useful in diagnosing MHE and predicting its outcomes. Neurophysiologic tests also provide useful information. The diagnosis of MHE is an important issue for clinicians and patients alike. Testing strategies depend on the normative data available, patient comfort, and local expertise.
Improving the Inhibitory Control Task to Detect Minimal Hepatic Encephalopathy
Gastroenterology, 2010
Quantification of the number of noninhibited responses (lures) in the inhibitory control task (ICT) has been proposed for the diagnosis of minimal hepatic encephalopathy (MHE). We assessed the efficacy of ICT compared with recommended diagnostic standards. METHODS: We studied patients with cirrhosis and healthy individuals (controls) who underwent the ICT at 2 centers (center A: n ϭ 51 patients and 41 controls, center B: n ϭ 24 patients and 14 controls). Subjects were evaluated for MHE by psychometric hepatic encephalopathy score (PHES). Patients from center B also were assessed for MHE by critical flicker frequency and spectral electroencephalogram analyses. RESULTS: Patients with cirrhosis had higher ICT lures (23.2 Ϯ 12.8 vs 12.9 Ϯ 5.8, respectively, P Ͻ .01) and lower ICT target accuracy (0.88 Ϯ 0.17 vs 0.96 Ϯ 0.03, respectively, P Ͻ .01) compared with controls. However, lures were comparable (25.2 Ϯ 12.5 vs 21.4 Ϯ 13.9, respectively, P ϭ .32) among patients with/without altered PHES (center A). There was a reverse, U-shaped relationship between ICT lure and target accuracy; a variable adjusting lures was devised based on target accuracy (weighted lures at center B). This variable differed between patients with and without MHE. The variable weighted lures was then validated from data collected at center A by receiver operator characteristic curve analysis; it discriminated between patients with and without PHES alterations (area under the curve ϭ 0.71 Ϯ 0.07). However, target accuracy alone was as effective as a stand-alone variable (area under the curve ϭ 0.81 Ϯ 0.06). CONCLUSIONS: The ICT is not useful for the diagnosis of MHE, unless adjusted by target accuracy. Testing inhibition (lures) does not seem to be superior to testing attention (target accuracy) for the detection of MHE.
2021
Background: Psychometric hepatic encephalopathy score (PHES) needs standardization for countries and is used for minimal hepatic encephalopathy (mHE) diagnosis. Assessing it is cumbersome.Aims: To standardize PHES for Turkish patients and compare it with German norms; to determine mHE prevalence with two different methods and to assess whether the PHES test can be simplified.Methods: Healthy volunteers (n=816; 400 male) and cirrhotics (n=124; 58 male) were included. PHES score threshold was set at ≤-5 points and that of critical flicker frequency (CFF) at <39 Hz for mHE diagnosis. For comparing German and Turkish norms, datasets were combined. Multiple backward procedure was applied. Receiver operating characteristic (ROC) curves were created for assessing diagnostic capabilities of single subtests of the PHES test. Results: Turkish norms displayed non-linear dependence on age and education. Rate of mHE in compensated cirrhotics was 29.8% and 27.4% with PHES and CFF tests, respec...
PubMed, 2009
Introduction: Minimal hepatic encephalopathy (mHE) has been reported in up to 84 percent of cirrhotics. The natural history of mHE has not been well-described. We designed a three-year prospective cohort study to determine the prevalence and natural history of mHE among cirrhotic patients. Methods: The patient cohort comprising 62 consecutive outpatients with cirrhosis were assessed at baseline and followed-up with a repeat assessment three years later. The assessments include: (1) Neuropsychometric analysis (digit-symbol substitution test, block-design test, number-connection test A); (2) Clinical, biochemical assessment; and (3) Quality of life (QOL) assessment (abbreviated sickness impact profile). Results: Baseline characteristics were: age 52.9 +/- 11.0 years; Child's A:B:C was 46:14:2. mHE was detected in 33.9 percent of the cohort. Older age, a higher Child-Pugh score and female gender were independently associated with mHE. mHE was associated with a poorer QOL. Follow-up assessment three years later showed that seven patients had died, while six were lost to follow-up; these patients had significantly higher baseline Child's scores. Of the remaining patients, 36/49 (73 percent) agreed to a repeat evaluation. In this group, none had mHE. QOL remained impaired despite the resolution of mHE. Conclusion: It has been shown for the first time that mHE can revert to a normal state in a significant proportion of patients with well-compensated cirrhosis.