Improving the Inhibitory Control Task to Detect Minimal Hepatic Encephalopathy (original) (raw)
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Journal of Gastroenterology and Hepatology Research, 2017
tests. On these 33 patients, ICT and CFF were applied. 35 healthy subjects served as controls for the ICT and CFF. RESULTS: Taking > 9 lures as positive ICT according to receiver operator characteristic (ROC) curve, the sensitivity, specificity, PPV and NPV were 90.9%, 37.1%, 57.6%, 81.3% respectively. Cirrhotics with MHE had significantly higher lures (22 ± 7.8 vs 11 ± 5.6, p < 0.001) or (56% vs 28%) and lower target response (90% vs 97%) compared with controls. For CFF taking < 37 Hz as cutoff , the sensitivity, specificity, PPV and NPV were 57.5%, 94.3%, 90.5% and 70.2%. We also found that CFF is less time consuming as compare to ICT. CONCLUSION: ICT and CFF are useful tools to assess MHE. CFF to be less time to consume, less sensitive but more specific than ICT.
Inhibitory Control Test for the Diagnosis of Minimal Hepatic Encephalopathy
Gastroenterology, 2008
Minimal hepatic encephalopathy (MHE) is difficult to diagnose. The Inhibitory Control Test (ICT) measures response inhibition and has diagnosed MHE with 90% sensitivity and specificity in a selected population; high lure and low target rates indicated poor ICT performance. We studied the reliability and validity of ICT for MHE diagnosis.ICT was compared with a psychometric battery (standard psychometric tests [SPT]) for MHE diagnosis and overt hepatic encephalopathy (OHE) prediction. ICT was administered twice for test-retest reliability, before/after transvenous intrahepatic portosystemic shunting (TIPS), and before/after yogurt treatment. The time taken by 2 medical assistants (MA) to administer ICT was recorded and compared with that of a psychologist for cost analysis.One hundred thirty-six cirrhotic patients and 116 age/education-matched controls were studied. ICT (>5 lures) had 88% sensitivity for MHE diagnosis with 0.902 area under the curve for receiver operating characteristic. MHE-positive patients had significantly higher ICT lures (11 vs 4, respectively, P = .0001) and lower targets (92% vs 97%, respectively, P = .0001) compared with MHE-negative patients. The test/retest reliability for ICT lures (n = 50, r = 0.90, P = .0001) was high. ICT and SPT were equivalent in predicting OHE (21%). ICT lures significantly worsened after TIPS (n = 10; 5 vs 9, respectively; P = .02) and improved after yogurt supplementation (n = 18, 10 vs 5, respectively; P = .002). The MAs were successfully trained to administer ICT; the time required for test administration and the associated costs were smaller for ICT than for SPT.ICT is a sensitive, reliable, and valid test for MHE diagnosis that can be administered inexpensively by MAs.
Saudi Journal of Gastroenterology, 2013
Neuropsychological tests for the diagnosis of MHE are established, time-tested tests, and are well characterized. However, they are time consuming and are influenced by age and educational status and need normative data which are available in a few countries only. [8,9] Critical flicker frequency (CFF) is a well-established neurophysiological ABSTRACT Background/Aim: Minimal hepatic encephalopathy (MHE) impairs health-related quality of life and driving ability of the patient. Objective: We assessed the utility of the inhibitory control test (ICT), critical flicker frequency (CFF), and psychometry in the diagnosis of MHE. Patients and Methods: Consecutive patients with cirrhosis underwent number connection tests A and B (NCT-A, B), digit symbol test (DST), line tracing test (LTT), serial dot test (SDT), CFF, and ICT at baseline and after four hours. Fifty healthy subjects served as controls for the ICT test. Results: Fifty patients with cirrhosis (43.4
Electroencephalography Versus Psychometric Tests in Diagnosis of Minimal Hepatic Encephalopathy
Journal of Neurology Research, 2016
Background: Minimal hepatic encephalopathy (MHE) in patients with liver cirrhosis is defined by the presence of otherwise unexplained cognitive abnormalities, only detectable on psychometric or neurophysiological testing, in the absence of overt hepatic encephalopathy (OHE). The objectives were to study the incidence of MHE in patients with liver cirrhosis, and to compare the sensitivity of the electroencephalography (EEG) versus psychometric hepatic encephalopathy score (PHES) in its diagnosis. Methods: This study was conducted on 50 patients with liver cirrhosis. All patients underwent complete medical and neurological examination, laboratory investigations, abdominal ultrasound, EEG, and PHES involving star construction test, the number connection tests, block design test, the digit symbol test, the line drawing test and the circle dotting test. Results: The neuropsychiatric symptoms (but not sufficient to diagnose OHE) were present in 40% of our patients. The psychometric test results were positive in 80% of them. EEG records showed that 64.7% of the patients had no slow waves, 23.5% showed theta waves, 9.8% showed delta waves, while no patients showed triphasic waves. There was a significant correlation between slow waves in EEG and inattention, amnesia and disturbed thinking (P < 0.05). Also, it was present between psychometric test results and inattention, amnesia, and sleep disturbances (P < 0.05). There was a very significant correlation between psychometric test and Child score (P < 0.05), while it was not present between Child score and slow waves in EEG records (P > 0.05). Conclusion: The PHES and EEG are important in diagnosis of MHE in patients with liver cirrhosis, but PHES appears to be more sensitive than EEG.
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.
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.
Metabolic Brain Disease, 1996
The prevalence of subclinical hepatic encephalopathy (SHE) varies according to the diagnostic tool used in its detection. Since a standardised approach to the diagnosis of SHE is not yet available, we compared psychometric tests and EEG spectral analysis. On the same day 32 cirrhotic patients without overt hepatic encephalopathy and 18 controls were assessed by psychometric tests, both standard and computerized (CPT), and by EEG spectral analysis (EEG-SA). The CPT, measuring reaction time (Rt) and errors (er), were Font, Choice), Choice2 and Scan test. The standard psychometric tests were the number connection test (NCT), the Reitan-B test, the Line Tracing Test [for time: LTT(t) and for errors : LTT(er)], and the Symbol Digit test (SD). Both psychometric tests [Reitan-B test, LTT(er) and CPT but Font (Rt) and Choice2 (er)] and EEG-SA parameters [mean dominant frequency (MDF) and theta power (0%)] significantly correlated (p<0 .05) with albumin plasma levels. LTT(er), Scan, Font, Choicel and Choice2 were significantly related to 0% and MDF. There was no control with positive EEG-SA, though one control was positive with LTT(t) and with the number of errors made during Font and Scan tests. The percentage of cirrhotics with positive EEG-SA was 34% (C1 95% =19-53), while 9-66% were positive with psychometric tests, depending on the test considered. In spite of the correlation between neuropsychological and neurophysiological parameters, the diagnostic agreement between EEG-SA and each psychometric test was not high. In conclusion : 1) neurophysiological and neuropsychological impairment in cirrhotics without overt hepatic encephalopathy were found linked to each other and to hepatic dysfunction ; 2) psychometric tests were not sufficiently good predictors of EEG alterations ; therefore, neuropsychological tools can not substitute neurophysiological ones to detect CNS dysfunction in liver disease .
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.