The animal naming test: An easy tool for the assessment of hepatic encephalopathy

Campagna, F.; Montagnese, Sara; Ridola, Lorenzo; Senzolo, Marco; Schiff, Sami; Rui, Michele De; Pasquale, Chiara; Nardelli, Silvia; Pentassuglio, I.; Merkel, Carlo; Angeli, Paolo; Riggio, Oliviero; Amodio, Piero

doi:10.1002/hep.29146

Cited by 150 publications

(150 citation statements)

References 45 publications

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“…The PHES ≤–4 was considered abnormal . Moreover, to support the diagnosis of MHE, all patients underwent the animal naming test, which assesses the maximum number of animals listed in 1 minute, as described . The assessors of MHE were blinded to patients’ pharmacological therapy.…”

Section: Methodsmentioning

confidence: 99%

Proton Pump Inhibitors Are Associated With Minimal and Overt Hepatic Encephalopathy and Increased Mortality in Patients With Cirrhosis

Nardelli¹,

Gioia²,

Ridola³

et al. 2019

Hepatology

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Minimal hepatic encephalopathy (MHE) is a subclinical cognitive impairment frequently observable in patients with cirrhosis. Proton pump inhibitors (PPIs) can contribute to small‐bowel bacterial overgrowth, but no study has investigated the link between PPIs and MHE. We investigated the relationship between MHE and PPI use as well as the role of PPI use in the development of overt HE and survival. Consecutive patients with cirrhosis (n = 310) were included in the study and followed up for 14.1 ± 12.3 months. At entry, MHE was diagnosed when the Psychometric Hepatic Encephalopathy Score was ≤–4. Data were analyzed by logistic regression for the factors associated with MHE and by time‐related models for overt HE development and survival. At inclusion, 131 out of 310 patients with cirrhosis (42%) were affected by MHE. One hundred and twenty‐five patients (40%) were using PPIs. The variables independently associated with the presence of MHE were PPI use, previous overt HE, low albumin, low sodium, and age. During follow‐up, the development of overt HE was higher (64% versus 25%, P < 0.001) and overall survival lower (41% versus 81%, P < 0.001) in PPI users than in nonusers. Variables independently associated with the development of overt HE were PPIs, history of overt HE, low albumin, MHE, and age, while variables independently associated with mortality were PPIs, development of overt HE, Model for End‐Stage Liver Disease score, low sodium, and age. Conclusion: The study identifies a potentially removable factor associated with the presence of MHE and related to the development of overt HE and survival in patients with liver cirrhosis.

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Section: Methodsmentioning

confidence: 99%

Proton Pump Inhibitors Are Associated With Minimal and Overt Hepatic Encephalopathy and Increased Mortality in Patients With Cirrhosis

Nardelli¹,

Gioia²,

Ridola³

et al. 2019

Hepatology

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“…However, this is highly dependent on the presence of the companion, familiarity of the patient to the clinician, as well as availability of time that is required for the practitioner to ask these questions. A recent study to better define grade 1 using the simple animal naming test has been published, which requires further validation in other centers to study its ability to define this grade . The deficiency in this knowledge was also highlighted by the relatively few respondents who ordered specialized testing for MHE to better define lower grades of HE.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the spectrum of hepatic encephalopathy: A multicenter study

et al. 2018

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Hepatic encephalopathy (HE) is a major cause of morbidity in cirrhosis. However, its severity assessment is often subjective, which needs to be studied systematically. The aim was to determine how accurately trainee and nontrainee practitioners grade and manage HE patients throughout its severity. We performed a survey study using standardized simulated patient videos at 4 US and 3 Canadian centers. Participants were trainees (gastroenterology/hepatology fellows) and nontrainees (faculty, nurse practitioners, physician assistants). We determined the accuracy of HE severity identification and management options between grades <2 or ≥2 HE and trainees/nontrainees. In total, 108 respondents (62 trainees, 46 nontrainees) were included. For patients with grades <2 versus ≥2 HE, a higher percentage of respondents were better at correctly diagnosing grades ≥2 compared with grades <2 (91% versus 64%; P < 0.001). Specialized cognitive testing was checked significantly more often in grades <2, whereas more aggressive investigation for precipitating factors was ordered in HE grades >2. Serum ammonia levels were ordered in almost a third of grade ≥2 patients. For trainees and nontrainees, HE grades were identified similarly between groups. Trainees were less likely to order serum ammonia and low-protein diets, more likely to order rifaximin, and more likely to perform a more thorough workup for precipitating factors compared with nontrainee respondents. There was excellent concordance in the classification of grade ≥2 HE between nontrainees versus trainees, but lower grades showed discordance. Important differences were seen regarding blood ammonia, specialized testing, and nutritional management between trainees and nontrainees. These results have important implications at the patient level, interpreting multicenter clinical trials, and in the education of practitioners. Liver Transplantation 24 587-594 2018 AASLD.

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“…The sensitivity of the test for diagnosing HE was 96% and the specificity (per definition) was 100% when comparing test results of patients with clinically OHE and healthy controls in the validation study [6]: 22% of the patients without clinical signs of HE achieved abnormal results in the PHES battery and were classified as having MHE. Campagna et al [10] recently found abnormal PHES results in 42.7% of 295 patients with liver cirrhosis but no OHE [ n = 50 (17%) had grade 1 HE, 76 (26%) had MHE].…”

Section: Minimal/covert Hepatic Encephalopathy: Psychometric Test Promentioning

confidence: 99%

“…After rough correction for age and education effects, the authors defined cut-off values for a (simplified) S-ANT score that, in their opinion, could be used for an estimation of a patients’ cognitive function. A score of ≥ 15 indicates a probability of about 80% that the subject has no cognitive dysfunction, a score of < 10 indicates the presence of encephalopathy with a probability of about 80% [10]. …”

Section: Minimal/covert Hepatic Encephalopathy: Psychometric Test Promentioning

confidence: 99%

Hepatic Encephalopathy: Definition, Clinical Grading and Diagnostic Principles

Weißenborn

2019

Drugs

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In general, hepatic encephalopathy (HE) is defined as a brain dysfunction caused by liver insufficiency and/or portal-systemic blood shunting. This article relates to the so-called type C HE: that is, HE in patients with liver cirrhosis. It manifests as a wide spectrum of neurological or psychiatric abnormalities, ranging from subclinical alterations, detectable only by neuropsychological or neurophysiological assessment, to coma. Several scales have been developed for grading the extent of HE. The most often used is the West Haven criteria (WHC), which differentiate between four grades of clinically overt HE. Patients with liver cirrhosis without clinically overt symptoms of HE but neuropsychological or neurophysiological findings indicating brain dysfunction are considered to have minimal hepatic encephalopathy (MHE). For simplification, some experts suggest differentiating between covert HE (MHE plus grade I HE according to WHC) and overt HE (WHC grades II–IV). Diagnosis of both MHE and overt HE is hampered by the fact that none of the symptoms of HE or the findings in the various diagnostic measures applied are specific. Thus, a diagnosis of HE or MHE can only be made after exclusion of other possible causes of brain dysfunction.

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The animal naming test: An easy tool for the assessment of hepatic encephalopathy

Abstract: The S-ANT is an easily obtainable measure useful for the assessment of HE. (Hepatology 2017;66:198-208).

Cited by 150 publications

References 45 publications

Proton Pump Inhibitors Are Associated With Minimal and Overt Hepatic Encephalopathy and Increased Mortality in Patients With Cirrhosis

Proton Pump Inhibitors Are Associated With Minimal and Overt Hepatic Encephalopathy and Increased Mortality in Patients With Cirrhosis

Assessment of the spectrum of hepatic encephalopathy: A multicenter study

Hepatic Encephalopathy: Definition, Clinical Grading and Diagnostic Principles

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