Detecção de encefalopatia hepática mínima através de testes neuropsicológicos e neurofisiológicos e o papel da amônia no seu diagnóstico

Bragagnolo, M.; Teodoro, Vinicius Vasconcelos; Lucchesi, Lígia Mendonça; Ribeiro, Tarsila Campanha da Rocha; Tufik, Sérgio; Kondo, Mário

doi:10.1590/s0004-28032009000100013

Cited by 7 publications

(8 citation statements)

References 31 publications

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“…The results of our study showed that 35% of the individuals (n=29) were diagnosed with CHE according to PHES results. This number is inferior to other studies evaluating the prevalence of MHE in Brazil, which demonstrated prevalence of 50% (17,18) . After evaluation through the Stroop App test, the prevalence observed rose up to 67%, indicating that the app has a high sensitivity (96.6%) but low specificity (49.1%) in diagnosing CHE.…”

Section: Discussioncontrasting

confidence: 79%

Use of the Stroop Encephalapp for Covert Hepatic Encephalopathy Screening in Cirrhotic Patients in Southern Brazil

JÚnior

Ziliotto

Ferreira

et al. 2020

Arq. Gastroenterol.

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BACKGROUND: Covert hepatic encephalopathy (CHE) is difficult to detect due to the lack of easily applicable screening tools. The Stroop EncephalApp is a smartphone application already validated for CHE screening. However, its applicability to the Brazilian population is not known. OBJECTIVE: To estimate the prevalence of CHE and evaluate the use of Stroop EncephalApp in a cirrhotic population in Brazil. METHODS: In this cross-sectional study, we evaluated 99 patients previously diagnosed with liver cirrhosis in a Private Hospital in Curitiba/PR. Patients were initially submitted to the mini mental state examination (MMSE) to exclude individuals with dementia. After, the Psychometric Hepatic Encephalopathy Score (PHES) test was performed and lastly, the Stroop EncephalApp test. Results were adjusted for age, sex and education levels to evaluate the accuracy of the app on detecting the disease, comparing its results with the gold standard method (PHES). Patients with one or more of the following were excluded: dementia, inadequate MMSE score, illiteracy, color blindness, history of drugs/alcohol abuse within the past 3 months and previous or actual episodes of encephalopathy. The statistical analysis was performed by SPSS 2.0 and the significance adopted by 5%. RESULTS: We included 82 individuals in the final analysis. Among these patients, 29 were diagnosed with CHE by the PHES test (35.36% prevalence) and 28 of those obtained equal diagnosis by the Stroop EncephalApp (96.6% sensitivity). A total of 53 patients obtained negative results for CHE by PHES, while the Stroop test classified 27 of them as having the disease. In the multivariate analysis, high levels of education were associated with better performance during the tests. No significant relationship was observed between age and sex with the probability of diagnosing CHE through the PHES test.

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Section: Discussioncontrasting

confidence: 79%

Use of the Stroop Encephalapp for Covert Hepatic Encephalopathy Screening in Cirrhotic Patients in Southern Brazil

JÚnior

Ziliotto

Ferreira

et al. 2020

Arq. Gastroenterol.

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“…This overlap may be related to the generation, absorption, and removal of ammonia which can be affected by a variety of intrahepatic and extrahepatic factors and ammonia may not be the only pathogenesis of HE [29]. Also, clinical testing and experimental studies have shown that patients with hyperammonemia do not necessarily have HE, and not all patients with HE show significantly elevated blood ammonia which requires us to distinguish HE from other diseases [30]. Therefore, the theory of ammonia toxicity alone cannot well explain the pathogenesis of HE, and it should be along with other hypotheses such as inflammatory response, oxidation, and nitrification stress, amino acid metabolism imbalance, neurotransmitter imbalance, and manganese toxicity.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Hemodynamics and Cognitive Function in Cirrhotic Patients with Hepatic Encephalopathy

Zhou

Dong

Zhang

et al. 2016

Gastroenterology Research and Practice

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Aims. To investigate cerebral hemodynamics in cirrhotic patients with HE and to observe effects of treatment in cerebral hemodynamics and correlations among ammonia, cerebral hemodynamics, and cognitive function. Methods. There were four groups: healthy controls (group 1), cirrhosis without HE (group 2), cirrhosis with MHE (group 3), and cirrhosis with OHE (group 4). Ammonia and cerebral hemodynamics (by TCD) were assessed. Patients in group 3 were subsequently randomized to two subgroups: the control (group A) and the treated (group B, treated with lactulose for two months), and they were retested for ammonia and TCD after treatment. Results. Ammonia, Vm, Vd, PI, and RI were statistically different before treatment, and ammonia, PI, and RI levels paralleled the severity of HE (P < 0.05). In group B, Vd increased and ammonia, PI, and RI declined following treatment (P < 0.05), while there were no differences in group A (P > 0.05). Correlations were found between ammonia and Vd, PI, RI, NCT-A, and DST and also found between Vd, PI, RI, and NCT-A and DST (P < 0.05). Conclusions. This study revealed that cerebral hemodynamics were related to the severity of HE and cerebral autoregulation was impaired. There were tight correlations among ammonia, cerebral hemodynamics, and cognitive function, and, following treatment, cerebral hemodynamics improved.

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“…For example, when Bragagnolo et al (2009) studied the applicability of the TMT-B for 48 Brazilian patients with cirrhosis, they found that populations with low, or very low, levels of education needed more time to execute the task. For this reason, its use in clinical practice is limited due to an absence of well-established cutoff points.…”

Section: Discussionmentioning

confidence: 99%

Cognitive assessment of patients with minimal hepatic encephalopathy in Brazil

2013

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Minimal hepatic encephalopathy is a syndrome caused by liver cirrhosis and accompanied by a broad spectrum of cognitive symptoms. The objective of the present study was to describe the prevalence of minimal hepatic encephalopathy in cirrhotic patients and to compare their cognitive performance with controls using standardized tests. Patients receiving medication or experiencing comorbidities associated with cognitive disorders were excluded. The final cohort was compared with a control-matched group using the Mini-Mental State Examination (MMSE), as well as Simple Drawing, Clock Drawing, Rey Auditory-Verbal Learning Test (RAVLT), Random Letter, Stroop, Trail-Making Test (TMT) A and B, Boston Naming, Category Verbal Fluency, Digit Span, Constructional Praxis, Processing Speed, and Similarities Tests. The results indicated no differences in the prevalence of cognitive complaints spontaneously reported by 29 patients with cirrhosis versus 22 healthy controls. The most affected tests included: MMSE (26.3 ± 2 vs. 28.1 ± 1.8 points; p = 0.004), learning (35.4 ± 9 vs. 41 ± 9.1 points; p = 0.041), retroactive interference (0.67 ± 0.22 vs. 0.84 ± 0.16 points; p = 0.004), and recognition (8.7 ± 2.6 vs. 11.2 ± 4.1 points; p = 0.024) in RAVLT, TMT-A (63.2 ± 29.3 vs. 47.6 ± 16.5 s; p = 0.029) and TMT-B (197.9 ± 88.1 vs. 146.8 ± 76.5 s; p = 0.03). No differences were observed with respect to age, gender, and education. In conclusion, MMSE proved to be a useful tool for detecting global cognitive impairment experienced by cirrhosis patients. Moreover, the most impaired cognitive functions were verbal episodic memory and information processing speed. These findings suggest that minimal hepatic encephalopathy represents a disorder that affects the medial temporal system and, possibly, the prefrontal cortex, and this requires further study.

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Detecção de encefalopatia hepática mínima através de testes neuropsicológicos e neurofisiológicos e o papel da amônia no seu diagnóstico

Abstract: Minimal hepatic encephalopathy is a frequent condition in cirrhotic patients. The arterial ammonia concentration does not play a major role in its diagnosis.

Cited by 7 publications

References 31 publications

Use of the Stroop Encephalapp for Covert Hepatic Encephalopathy Screening in Cirrhotic Patients in Southern Brazil

Use of the Stroop Encephalapp for Covert Hepatic Encephalopathy Screening in Cirrhotic Patients in Southern Brazil

Cerebral Hemodynamics and Cognitive Function in Cirrhotic Patients with Hepatic Encephalopathy

Cognitive assessment of patients with minimal hepatic encephalopathy in Brazil

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