Psychomotor Performance Defects in Cirrhotic Patients Without Overt Encephalopathy

Cognitive deficits related to major organ failure: The potential role of neuropsychological testing

“…Tarter et al (1986) found that the severity of certain cognitive deficits, particularly visuospatial and memory deficits, was related to various quantitative biochemical measures of liver dysfunction (e.g., alanine transaminase and fasting plasma ammonia level elevations, and increased prothrombin time). Gilberstadt et al (1980) also found several cognitive measures to be correlated with a general severity of liver disease measure, and particularly with serum albumin level. In their review of various studies, Tarter et al (1988b) note that several studies have found correlations between liver function tests and cognitive deficits, with perhaps serum albumin level and gamma-globulin concentrations being the best predictors of performance.…”

“…Verbal ability is rarely affected early in liver disease cases, and thus verbal ability may mask underlying impairments (Rehnstr6m et al, 1977). Early studies showed the efficacy of such neuropsychological tests as the Trail-Making Test (TMT) and other performance tests in detecting cognitive dysfunction in cirrhotic patients (cirrhosis confirmed by liver biopsy or clinical diagnosis) with no overt clinical evidence of PSE (Gilberstadt et al, 1980;Zeegen et al, 1970). (Although Gilberstadt et al, 1980, noted that when age corrections were used on the TMT, group differences disappeared.)…”

“…Later studies have confirmed that neuropsychological testing is as or more sensitive than EEG in identifying early signs of encephalopathy in liver disease patients (McLaughlin and Koff, 1989;Puca et al, 1988;Rehnstr6m et al, 1977). However, some studies have selected patients for comparison based on the presence or absence of overt encephalopathy; results of these studies are difficult to interpret given that early signs of brain damage are detectable, albeit subtle, in apparently nonencephalopathic patients (e.g., Gilberstadt et al, 1980;Puca et al, 1989;. If indeed there is the possibility of a continuum of the severity of cognitive deficits in liver disease patients, the usefulness of such groups as controls is limited.…”

“…In studies comparing alcoholics with and without cirrhosis, cirrhotic alcoholics have been found to be worse than noncirrhotic alcoholics on various neuropsychological measures (Gilberstadt et aL, 1980;Smith and Smith, 1977). Cirrhotic alcoholics and cirrhotic nonalcoholics were found to be similarly impaired, and worse than alcoholics without cirrhosis, on various neuropsychological tasks (Rehnstr6m et aL, 1977).…”

The Clinical Relevance of Minimal Hepatic Encephalopathy - A Critical Look

“…The neuropsychological profile of mHE was predominantly elaborated in the 1970s and 1980s by application of large batteries of psychometric tests to patients with liver cirrhosis compared to controls [2,3,4,5]. Thereby, it was shown that mHE is characterized by psychomotor slowing, deficits in attention, visual perception, visuoconstructive abilities, as well as motor speed and accuracy.…”