Clinical features and survivial of cirrhotic patients with subclinical cognitive alterations detected by the number connection test and computerized psychometric tests

Abstract

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

Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy

“…A Z score less than Ϫ2 was considered abnormal. 13,36 A mean Z score (mZS) was calculated for each patient in order to avoid bias related to multiple comparisons. Changes in the number of abnormal NP tests and in the mZS after 3 months of treatment or follow-up were referred to as ⌬ab-normal NP tests and ⌬mZS, respectively, and served as measures of psychometric change.…”

“…[9][10][11][12] Finally, it is associated with a poor prognosis. 13,14 Thus, MHE may warrant attempts at treatment.…”

Minimal Hepatic Encephalopathy Impairs Quality of Life

“…7,10,12,[16][17][18] MHE predicts the development of overt HE and also adversely affects survival as shown by several studies. 7,10,18,[84][85][86][87] Das et al 10 studied the progression of MHE to overt HE in relation to severity of liver dysfunction and found that overt HE were more frequent in patients with MHE and Child-Turcotte-Pugh (CTP) score >6. Hartmann et al 7 found that survival was determined only by CTP score irrespective of presence or absence of MHE.…”

Brain Perfusion Single Photon Emission Computed Tomography Abnormalities in Patients with Minimal Hepatic Encephalopathy

“…Semi-quantitative analysis of the Tc-99m ECD uptake was performed using the region of interest (ROI) templates. 10 Region of interest templates were drawn on paired regions of both cerebral cortices and unpaired regions in the mid-sagittal image. Mean counts in each ROI of the SPECT image is influenced by various factors, like dose of the tracer injected and time of acquisition from the time of injection.…”

“…3,4 Early detection of MHE is clinically relevant for several reasons. Minimal hepatic encephalopathy impairs daily functioning and health-related quality of life (HRQOL), 5,6 it predicts the development of overt HE, 7,8 it is associated with poor prognosis, 9,10 and these patients experience higher rates of accidents, driving problems, and falls. [11][12][13][14] Furthermore, treatment with lactulose or rifaximin improves cognitive functions as well as HRQOL and driving simulator performance in these patients.…”