Improving the Inhibitory Control Task to Detect Minimal Hepatic Encephalopathy

Amodio, Piero; Schiff, Sami; Montagnese, Sara; Pasquale, Chiara; Nardelli, Silvia; Pentassuglio, I.; Trezza, Mónica Adriana; Marzano, C.; Flaiban, Cristiana; Angeli, Paolo; Cona, Giorgia; Bisiacchi, Patrizia; Gatta, Angelo; Riggio, Oliviero

doi:10.1053/j.gastro.2010.04.057

Cited by 84 publications

(82 citation statements)

References 41 publications

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“…Another important point is the difference in ICT lures values in controls between different populations. The value in Indian patients in the present study (11.3 AE 5.6) was similar to the value reported in Italian patients (12.9 AE 5.8) 21 but higher than in the US population (3 AE 2). 19,20 Differences in age, gender and education level do not explain the difference in control values from previous studies 19,20 since the study populations were comparable (Table 5).…”

Section: Discussionsupporting

confidence: 88%

“…The present study confirms observations of Amodio and co-workers. 21 Although the response to ICT lures was significantly higher and the response to correct targets was significantly lower in patients with cirrhosis and MHE than in those without MHE and in controls, there was considerable overlap between the groups, limiting the ability of these ICT parameters to discriminate between these groups. Further, our results demonstrated that neither lure weighted by target accuracy nor the sum of PHES score and ICT lures could further improve upon the diagnostic accuracy of PHES alone.…”

Section: Discussionmentioning

confidence: 96%

“…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%

“…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. 19,20 However, Amodio et al 21 have demonstrated that the ICT is not useful for the diagnosis of MHE, unless adjusted by target accuracy. Testing inhibition (lures) does not seem to be superior to testing attention (target accuracy) for the detection of MHE.…”

Section: Discussionmentioning

confidence: 99%

“…19,20 However, it requires that the subject be familiar with the use of computers and needs to be validated in other populations as well. Amodio et al 21 assessed the efficacy of ICT compared with diagnostic standards and found that ICT is not useful for the diagnosis of MHE, unless adjusted by target accuracy.…”

mentioning

confidence: 99%

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

Taneja¹,

Dhiman²,

Khatri³

et al. 2011

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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