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

Abstract

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)

Hepatobiliary Quiz-5 (2013)

“…22,23 However, studies have found it to be inferior to PHES for the diagnosis of MHE or prediction of disease severity or survival. 24,25 6. Correct answers: 2,3 and 5 HBV produces 3 different types of virus-related particles.…”

Diagnosis of Minimal HE—And the Temptation of Easy Solutions

“…[2][3][4] By applying comprehensive psychometric test batteries they were able to show that mHE is characterized by deficits in attention, visual perception, visuo-spatial construction, motor speed and accuracy, especially, while other domains such as language or memory are spared. 13 The PSE-Syndrome-Test-a paper-pencil-test comprising 5 subtests-is kind of a relict of the 1980s. A lot of different methods have been used since: the Number Connection Tests A and B, the Block Design Test and as the first neurophysiological means visually analyzed electroencephalograms (EEG) in the 1970s and early 80s, then computerized psychometric tests and evoked potentials as well as spectral EEG analysis in the 90s, critical flicker frequency in the beginning of the new century and finally the Inhibitory Control Test (ICT), a computerized test of attention and response inhibition in 2007.…”

“…But, the provision of norm data which is needed for any new population that shall be studied takes time and effort, and is not really honored by the scientific community. 13 In their study the test battery providing the PHES is a little bit different from the usual battery as the Number Connection Test B was substituted by the Figure Connection Test. Thus, there is the desire for more elegant, e.g.…”

“…Thus, there is the desire for more elegant, e.g. 13 The three groups who evaluated the ICT for diagnosing mHE so far appear to be following different aims. The "Inhibitory Control Test (ICT)" is the most recent candidate.…”