Attention Dysfunction in Cirrhotic Patients: An Inquiry on the Role of Executive Control, Attention Orienting and Focusing

Amodio, Piero; Schiff, Sami; Piccolo, F. Del; Mapelli, Daniela; Gatta, Angelo; Umiltà, Carlo

doi:10.1007/s11011-005-4149-3

Cited by 64 publications

(63 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results replicate prior studies of the paper Stroop tests in cirrhosis and also our study with the old App in an entirely new set of subjects and furthers it with study of validation and age-based cut-offs 3–6 . The relatively high educational background of our subjects may limit its generalizability.…”

Section: Discussionsupporting

confidence: 89%

“…Therefore despite being aware of the negative impact of CHE on quality of life, driving capability and overall progression to overt HE, most practitioners are not able to detect it 2 . The Stroop test, which evaluates cognitive flexibility and psychomotor speed, has been used to diagnose CHE in paper-pencil and electronic formats 3–5 . The recent use of an App based on Stroop testing by our group showed good differentiation between groups with and without CHE 6 .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Validation of EncephalApp, Smartphone-Based Stroop Test, for the Diagnosis of Covert Hepatic Encephalopathy

Bajaj

Heuman

Sterling

et al. 2015

Clinical Gastroenterology and Hepatology

132

124

View full text Add to dashboard Cite

Background & Aims Detection of covert hepatic encephalopathy (CHE) is difficult but point of care testing could increase rates of diagnosis. We aimed to validate the ability of the smartphone app EncephalApp, a streamlined version of Stroop App, to detect CHE. We evaluated face validity, test–retest reliability, and external validity. Methods Patients with cirrhosis (n=167; 38% with overt HE [OHE]; mean age, 55 years; mean model for end-stage liver disease score, 12) and controls (n=114) were each given a paper and pencil cognitive battery (standard) along with EncephalApp. EncephalApp has Off and On states; results measured were: OffTime, OnTime, OffTime+OnTime, and number of runs required to complete 5 off and on runs. Thirty-six patients with cirrhosis underwent driving simulation tests, and EncephalApp results were correlated with results. Test–retest reliability was analyzed in a subgroup of patients. The test was performed before and after transjugular intra-hepatic portosystemic shunt placement, before and after correction for hyponatremia, to determine external validity. Results All patients with cirrhosis performed worse on paper and pencil and EncephalApp tests than controls. Patients with cirrhosis and OHE performed worse than those without OHE. Age-dependent EncephalApp cut-offs (younger or older than 45 years) were set. An OffTime+OnTime value of >190 seconds identified all patients with CHE with an area under the receiver operator characteristic (AUROC) value of 0.91; the AUROC value was 0.88 for diagnosis of CHE in those without OHE. EncephalApp times correlated with crashes and illegal turns in driving simulation tests. Test–retest reliability was high (intra-class coefficient, 0.83) among 30 patients retested 1–3 months apart. OffTime+OnTime increased significantly (206 vs 255, P=.007) among 10 patients retested 33±7 days after transjugular intra-hepatic portosystemic shunt placement. OffTime+OnTime decreased significantly (242 vs 225, P=.03) in 7 patients tested before and after correction for hyponatremia (126±3 to 132±4 meq/L, P=.01), 10±5 days apart. Conclusions A smartphone app called EncephalApp has good face validity, test–retest reliability, and external validity for the diagnosis of CHE.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Validation of EncephalApp, Smartphone-Based Stroop Test, for the Diagnosis of Covert Hepatic Encephalopathy

Bajaj

Heuman

Sterling

et al. 2015

Clinical Gastroenterology and Hepatology

132

124

View full text Add to dashboard Cite

show abstract

“…Hence, the conclusions as noted above[35]. Impaired response inhibition (as detected by ICT/illegal turns) is known to be associated with MHE and causes alteration of executive control[35, 43]. The above study supports the results of earlier smaller study by Nyberg et al in a larger cohort of well controlled, non- alcoholic subjects about navigation skills in MHE[44].…”

Section: What Goes Wrong With Driving In Che: Fatigue Navigational Ssupporting

confidence: 84%

Covert Hepatic Encephalopathy

Shaw

Bajaj²

2017

Journal of Clinical Gastroenterology

View full text Add to dashboard Cite

Liver cirrhosis is a public health problem and hepatic encephalopathy (HE) is one of its main complications, which can be either overt meaning thereby evident and readily diagnosed, or covert/minimal (CHE) needing psychometric testing for diagnosis. Patients with CHE hepatic encephalopathy have deficits in multiple domains including visuo-spatial assessment, attention, response inhibition, working memory, along with psychomotor speed to name a few areas. These patients have poor navigational skills, get fatigued easily and demonstrate poor insight into their driving deficits. The combination of all these leads them to have poor driving skills leading to traffic violations and crashes as demonstrated not only on the simulation testing but also in real life driving events. There are multiple psychometric tests for CHE testing but these are not easily available and there is no uniform consensus on the gold standard testing as of yet. It does not automatically connote that all patients who test positive on driving simulation testing are unfit to drive. The physicians are encouraged to take driving history from the patient and the care- givers on every encounter and focus their counseling efforts more on patients with recent history of traffic crashes, with abnormal simulation studies and history of alcohol cessation within last year. As physicians are not trained to determine fitness to drive, their approach towards CHE patients in regards to driving restrictions should be driven by ethical principles while as respecting the local laws.

show abstract

“…For example, attention deficit is one of the main components of MHE19. The anterior attention system, which is hypothesized to modulate response inhibition, behavioral selection, and executive control, is sensitive to early HE37. In fact, impaired executive function is well documented in MHE69.…”

Section: Discussionmentioning

confidence: 99%

Aberrant salience network and its functional coupling with default and executive networks in minimal hepatic encephalopathy: a resting-state fMRI study

Chen

et al. 2016

Sci Rep

View full text Add to dashboard Cite

The purposes of this study are to explore functional alterations in salience network (SN) and its functional coupling with default mode (DMN) and central executive (CEN) networks in minimal hepatic encephalopathy (MHE). Twenty cirrhotic patients with MHE, 23 cirrhotic patients without MHE (NHE), and 18 controls underwent resting-state fMRI and psychometric hepatic encephalopathy score (PHES) test. Independent component analysis was performed to obtain DMN (including three subsystems: anterior, inferior-posterior, and superior-posterior DMN [a/ip/spDMN]), SN, and CEN (including three subsystems: left-ventral, right-ventral, and dorsal CEN [lv/rv/dCEN]). The intrinsic functional connectivity (iFC) within (intra-iFC) and between (inter-iFC and time-lagged inter-iFC) networks was measured. MHE patients showed decreased intra-iFC within aDMN, SN, lvCEN, and rvCEN; and decreased inter-iFC and time-lagged inter-iFC between SN and ipDMN/spDMN/lvCEN and increased inter-iFC and time-lagged inter-iFC between SN and aDMN, compared with controls. A progressive trend in connectivity alterations was found as the disease developed from NHE to MHE. The inter-iFC between ipDMN/spDMN and SN was significantly correlated with PHES score. In conclusion, an aberrant SN and its functional interaction with the DMN/CEN are core features of MHE that are associated with disease progression and may play an important role in neurocognitive dysfunction in MHE.

show abstract

Attention Dysfunction in Cirrhotic Patients: An Inquiry on the Role of Executive Control, Attention Orienting and Focusing

Cited by 64 publications

References 31 publications

Validation of EncephalApp, Smartphone-Based Stroop Test, for the Diagnosis of Covert Hepatic Encephalopathy

Validation of EncephalApp, Smartphone-Based Stroop Test, for the Diagnosis of Covert Hepatic Encephalopathy

Covert Hepatic Encephalopathy

Aberrant salience network and its functional coupling with default and executive networks in minimal hepatic encephalopathy: a resting-state fMRI study

Contact Info

Product

Resources

About