Computerized Psychometric Testing in Minimal Encephalopathy and Modulation by Nitrogen Challenge and Liver Transplant

Mardini, Hanan Al; Saxby, Brian K.; Record, C. O.

doi:10.1053/j.gastro.2008.06.043

Cited by 68 publications

(48 citation statements)

References 38 publications

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“…Lately, computerized tests directed toward the study of the cognitive domains have been used for the diagnosis of MHE. The ICT, [19][20][21] together with the scan test 32,33 and possibly the Cognitive Drug Research battery 34 are the only computerized tests that have been expressly applied to patients with cirrhosis based on known cognitive features of MHE. ICT is a test of attention and response inhibition and has been proposed as a simple diagnostic tool for diagnosis of MHE with a high sensitivity and specificity.…”

Section: Discussionmentioning

confidence: 99%

Inhibitory Control Test for the Detection of Minimal Hepatic Encephalopathy in Patients with Cirrhosis of Liver

Taneja

Dhiman

Khatri

et al. 2012

Journal of Clinical and Experimental Hepatology

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Background & aims: Minimal hepatic encephalopathy (MHE) has significant impact on future clinical outcomes, such as occurrence of overt HE (OHE) and survival in patients of cirrhosis. In the absence of a 'gold standard', psychometric hepatic encephalopathy score (PHES) is widely used for the diagnosis of MHE. This cross-sectional and prospective study was carried out to determine the usefulness of inhibitory control test (ICT) for the diagnosis of MHE. Methods: One hundred and two patients with cirrhosis and without a history of OHE were enrolled in to the study and were subjected to PHES and ICT. MHE was diagnosed when the PHES was # À5. ICT was considered abnormal when the numbers of ICT lures were more than 14. Results: Forty-one (40.2%) patients had MHE. There were 40 patients with normal PHES and ICT, 32 with abnormal PHES and ICT, 9 with abnormal PHES and normal ICT, and 21 with abnormal ICT and normal PHES score. ICT had 78% sensitivity and 65.6% specificity and an areaunder-the-curve value of 0.735 (95% CI = 0.632-0.830) for the diagnosis of MHE. In patients with cirrhosis, ICT did not correlate with severity of liver disease as measured by CTP score (r = 0.044, P = 0.658) and MELD score (r = 0.176, P = 0.077). ICT did not predict survival as well as PHES; while 6 (11.3%) patients died among those who had altered ICT compared to 4 (8.2%) patients who did not have altered ICT (P = 0.74), 8 (19.5%) patients died among those who had altered PHES compared to 2 (3.3%) patients who did not have altered PHES (P = 0.013). Conclusion: ICT is not as useful as PHES in diagnosing MHE in patients with cirrhosis of the liver. It does not correlate with disease severity and predict survival as well as PHES. ( J CLIN EXP HEPATOL 2012;2:306-314)

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Section: Discussionmentioning

confidence: 99%

Inhibitory Control Test for the Detection of Minimal Hepatic Encephalopathy in Patients with Cirrhosis of Liver

Taneja

Dhiman

Khatri

et al. 2012

Journal of Clinical and Experimental Hepatology

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“…Patients were offered treatment with oral LOLA (9 g/d) with the aim of improving the subjective symptoms of mental slowing and objective psychometric performance. In addition, 21 neurologically healthy adult controls with no history of liver disease were recruited (mean [SD] age 44 [9] years, 11 female). Control subjects only underwent the MRI component of the protocol below, and were scanned once without pharmacologic intervention.…”

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confidence: 99%

“…Laboratory reference ranges were used for biochemical parameters, whereas published age-and educationadjusted normal reference ranges were used for PHES 8 and Computerized Drug Research (CDR) batteries. 9 Child-Pugh 17 and Model for End-Stage Liver Disease 18 (MELD) scores for each patient were calculated.…”

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confidence: 99%

“…Two well-validated psychometric batteries were used on the same day as each MRI examination: the paper-based PHES 8 and the CDR battery. 9 The CDR subtests have been previously described 9 and are related to the following cognitive processes: power of attention, continuity of attention, episodic memory, working memory, and speed of memory. The CDR battery was presented on a laptop computer with participants responding via a 2-button YES/NO response box, thus requiring no prior computer experience.…”

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Modulation of neural activation following treatment of hepatic encephalopathy

et al. 2013

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Objective: To measure changes in psychometric state, neural activation, brain volume (BV), and cerebral metabolite concentrations during treatment of minimal hepatic encephalopathy.Methods: As proof of principle, 22 patients with well-compensated, biopsy-proven cirrhosis of differing etiology and previous minimal hepatic encephalopathy were treated with oral L-ornithine L-aspartate for 4 weeks. Baseline and 4-week clinical review, blood chemistry, and psychometric evaluation (Psychometric Hepatic Encephalopathy Score and Cognitive Drug Research Score) were performed. Whole-brain volumetric and functional MRI was conducted using a highly simplistic visuomotor task, together with proton magnetic resonance spectroscopy of the basal ganglia. Treatment-related changes in regional BV and neural activation change (blood oxygenation level dependent) were assessed.Results: Although there was no change in clinical, biochemical state, basal ganglia magnetic resonance spectroscopy, or in regional BV, there were significant improvements in Cognitive Drug Research Score (11.2, p 5 0.003) and Psychometric Hepatic Encephalopathy Score (11.5, p 5 0.003) with treatment. This cognitive amelioration was accompanied by changes in blood oxygenation leveldependent activation in the posterior cingulate and ventral medial prefrontal cortex, 2 regions that form part of the brain's structural and metabolic core. In addition, there was evidence of greater visual cortex activation. Conclusions:These structurally interconnected regions all showed increased function after successful encephalopathy treatment. Because no regional change in BV was observed, this implies that mechanisms unrelated to astrocyte volume regulation were involved in the significant improvement in cognitive performance. LOLA 5 L-ornithine L-aspartate; MD 5 mean difference; MELD 5 model for end-stage liver disease; MHE 5 minimal hepatic encephalopathy; mI 5 myo-inositol; MRS 5 magnetic resonance spectroscopy; NAA 5 N-acetylaspartate; OHE 5 overt hepatic encephalopathy; PHES 5 Psychometric Hepatic Encephalopathy Score; QoEM 5 Quality of Episodic Memory; SIENA 5 Structural Image Evaluation, using Normalisation, of Atrophy; SoM 5 Speed of Memory; TE 5 echo time; TR 5 repetition time.

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“…Il CDR, è composto da una batteria di 5 test psicometrici somministrati al computer, i quali permettono di indagare il grado di attenzione (livello e mantenimento) e la memoria (velocità e qualità). Il CDR ha dimostrato elevata sensibilità nel diagnosticare l'EE Minima, sebbene non sia stato ancora validato [73].…”

Section: Approccio Al Paziente Cirrotico Con Ee Overtunclassified

A look at the hepatic encephalopathy in cirrhosis

Zaccherini

Tufoni

Ricci

et al. 2013

RHC

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Hepatic encephalopathy (HE) is a neuropsychiatric syndrome complicating acute and chronic liver failure and characterized by a wide range of manifestations, in absence of other brain disease. HE is very frequent in course of cirrhosis and even mild forms involve a great additional burden on patients, their families and health-care resources. Its onset affects subsequent survival of patients. Historically, pathophysiology of HE was connected to several substances (mostly ammonia) produced in the gut and normally metabolized by the liver, but more recently other factors such as inflammation, bacterial translocation and oxidative stress have shown a crucial role. Symptoms are often overt (confusion, asterixis, disorientation, ataxia or coma) but can also be subtle (sleep disturbances, cognitive impairment, mood alterations, impairment of executive decision-making, and psychomotor speed -Minimal HE); the West Haven Criteria are most often used to grade Overt HE (OHE), with grade ranging from 0 to 4 (4 corresponding to coma). Since both Minimal HE and grade 1 HE cannot be diagnosed by clinical examination and need for specific tests, it results practical to combine these entities and name them "Covert" HE (CHE) to aid clinical use. Diagnosis is based on evidence of neurological impairment in presence of liver cirrhosis, only after the exclusion of other brain diseases. Measurement of serum ammonia and electroencephalography are little specific, while brain magnetic resonance and search for portosystemic shunts are important in complex cases. Diagnosis of OHE is often just clinical, while that of CHE requires dedicated psychometric and neurophysiological tests. Although these tests are difficult to be performed in the clinical practice, detection and treatment of CHE are cost-effective and important; indeed, CHE affects patients' quality of life, socioeconomic status and driving skills, and increases the risk for falls, car accidents, development of OHE, and death. Management of HE includes early diagnosis and prompt treatment of precipitating factors (infection, gastrointestinal bleeding, electrolyte disturbances, dehydration, hypotension, use of benzodiazepines, psychoactive drugs, and/or alcohol). Current treatment is based principally on reducing intestinal ammonia with nonabsorbable disaccharides (lactulose or lactitol); rifaximin, used solely or in addition, is also becoming a first-line treatment. Keywords Liver cirrhosis; Overt hepatic encephalopathy; Covert hepatic encephalopathy; Minimal hepatic encephalopathy Uno sguardo all'encefalopatia epatica nella cirrosiA look at the hepatic encephalopathy in cirrhosis Uno sguardo all'encefalopatia epatica nella cirrosi Introduzione L' encefalopatia epatica (EE) è una forma di sofferenza cerebrale che spesso complica il decorso della cirrosi epatica. L'EE è caratterizzata da un ampio spettro di alterazioni neuropsicologiche e neuropsichiatriche, con differenti livelli di severità, da forme subcliniche fino a stupor e coma, in assenza di altre patologie cerebra...

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Computerized Psychometric Testing in Minimal Encephalopathy and Modulation by Nitrogen Challenge and Liver Transplant

Cited by 68 publications

References 38 publications

Inhibitory Control Test for the Detection of Minimal Hepatic Encephalopathy in Patients with Cirrhosis of Liver

Inhibitory Control Test for the Detection of Minimal Hepatic Encephalopathy in Patients with Cirrhosis of Liver

Modulation of neural activation following treatment of hepatic encephalopathy

A look at the hepatic encephalopathy in cirrhosis

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