The prevalence and the clinical implications of subclinical cognitive alterations in cirrhotic patients have not been well defined as yet. Therefore, we performed a study to assess the clinical features and the survival of cirrhotic patients with cognitive alterations detected by the number connection test (NCT) and a set of computerized psychometric tests (Scan, Choice1, and Choice2) measuring the reaction times and the percentage of errors in performing specific tasks. Ninety-four cirrhotic patients (aged 58 ؎ 9 years) without overt hepatic encephalopathy and 80 controls (aged 53 ؎ 15 years) were consecutively enrolled. The median follow-up in cirrhotic patients was 426 days (lower quartile ‫؍‬ 213 days; upper quartile ‫؍‬ 718 days). Results of the NCT, Scan test, and Choice2 test were significantly worse in cirrhotic patients, whereas Choice1 did not differ significantly from the controls. In cirrhotic patients, the prevalence of altered psychometric tests was 21% (CI 95% ‫؍‬ 14%-31%) by NCT, 23% (CI 95% ‫)%33-%51؍‬ by Scan test, and 20% (CI 95% ‫)%03-%61؍‬ by Choice2 test. The alterations of NCT, Scan, and Choice2 were found to be related to the severity of liver disease, independently of its etiology. Increased risk of death was found to be associated with altered Scan test (hazard ratio ‫؍‬ 2.4; CI 95% ‫,)3.5-1.1؍‬ or altered Choice2 test (hazard ratio ‫؍‬ 2.8; CI 95% ‫؍‬ 1.2-6.3). Multivariate regression showed that Scan and Choice2 tests had prognostic value on survival, in addition to Child-Pugh classes in the first year of follow-up. (HEPATOLOGY 1999;29: 1662-1667

No abstract

No abstract

No abstract

Attentional dysfunction, which influences overall cognitive productivity, is not well characterized in cirrhotic patients. The aim of this study was to clarify the features of covert visual attention orienting in cirrhotics without overt hepatic encephalopathy. One hundred consecutive cirrhotic patients and 40 controls were enrolled. Visual covert attention orienting was assessed by the Posner test, which evaluates the effect of a cue on visual reaction times. Patients were characterized by the number connection test (NCT) and electroencephalographic (EEG) spectral analysis. The severity of liver disease was graded using standard laboratory parameters and the Child-Pugh's classification. Fifty-five psychometric and EEG evaluations were performed in the follow-up of 17 patients to assess the relationship between the variations of psychometric and neurophysiological findings. NCT and quantified-EEG parameters (altered in 19% and 40% of cirrhotic patients, respectively) were linked to each other and to the severity of liver disease. The Posner test showed a delay of visual reaction times in class B-C cirrhotic patients. Reaction times were correlated with ammonia and EEG parameters. The effect of the cue was higher in cirrhotic patients than in controls, particularly in the invalid position. This study suggests that cirrhotic patients have a reduced activity rate and reduced capacity to disengage attention previously focused on a cue. Such alterations are linked to NCT and EEG findings. (HEPATOLOGY 1998;27:1517-1523.)Cirrhotic patients have a high prevalence, ranging from 30% to 70%, of subtle cognitive or neurophysiological alterations notwithstanding an almost-normal neurological exam. [1][2][3][4][5][6]