The number connection tests A and B: interindividual variability and use for the assessment of early hepatic encephalopathy

Weißenborn, Karin; Rückert, Norbert; Hecker, Hartmut; Manns, Michael P.

doi:10.1016/s0168-8278(98)80289-4

Cited by 122 publications

(115 citation statements)

References 18 publications

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“…The assessment included a detailed neurological examination, neuropsychological tests, and the Unified Parkinson's Disease Rating Scale (UPDRS), a currently accepted and validated clinical scale for the evaluation of patients with Parkinson's disease [30]. The neurological examination was performed while the patients were in stable condition by senior neurologists (R.D.P, P.B, F.V.)…”

Section: Neurological Assessmentmentioning

confidence: 99%

Persistence of mild parkinsonism 4 months after liver transplantation in patients with preoperative minimal hepatic encephalopathy: a study on neuroradiological and blood manganese changes

Lazeyras

Pasquier

Delavelle

et al. 2002

Transplant International

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Pallidal hyperintensity at magnetic resonance imaging (MRI) correlates to blood manganese (Mn) levels and parkinsonian signs in patients with cirrhosis. Similarly, metabolite changes in the basal ganglia (BG) at proton spectroscopy are related to these neurological signs. The evolution of these abnormalities after liver transplantation (OLT) is incompletely described. We evaluated 14 unselected consecutive patients with cirrhosis (minimal hepatic encephalopathy [HE] n = 8, no HE n = 6) before and 4 months after successful OLT for the evolution of parkinsonism using a validated scale (the United Parkinson's Disease Rating Scale, or UPDRS). Pallidal intensity at MRI, spectroscopic changes in the BG at magnetic resonance spectroscopy (MRS), and whole blood manganese concentrations were measured. After OLT in patients with preoperative minimal HE, the UPDRS scores improved, but mild parkinsonism persisted (16.1 2r3.6 to 6.2f4.8, P < 0.05). Pallidal hyperintensity remained abnormal in 5/8 of cases, but spectroscopic changes normalized in all patients. Blood Mn remained elevated in 4/6 patients. In patients without HE, UPDRS values remained negligible (2.42 f 1.5 to 2.5 + 1.4). Pallidal hyperintensity normalized in 7/8 patients and spectroscopic changes normalized in all patients. Blood Mn remained elevated in 5/6 patients. Four months after successful OLT, patients with preoperative minimal HE and severe pallidal hyperintensity showed persistent mild parkinsonism. The role of blood manganese determination appears limited in the monitoring of MRI and parkinsonian signs changes after OLT.

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Section: Neurological Assessmentmentioning

confidence: 99%

Persistence of mild parkinsonism 4 months after liver transplantation in patients with preoperative minimal hepatic encephalopathy: a study on neuroradiological and blood manganese changes

Lazeyras

Pasquier

Delavelle

et al. 2002

Transplant International

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“…In these tests, the results were measured as NCT-A, NCT-B, SDT, LDT in seconds and DST in points. Tests were considered abnormal when test score was more than mean±2 standart deviations (SD) in comparison with that of the age-and education-matched controls (12,13). In addition, the patients who had ≥2 abnormal psychometric test results were accepted as MHE (6,14 …”

Section: Psychometric Testsmentioning

confidence: 99%

Critical flicker frequency test for diagnosing minimal hepatic encephalopathy in patients with cirrhosis

Coşkun¹,

Özen²

2017

Turk J Gastroenterol

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“…It can be circumvented to an extent by administering parallel version of the test in follow-up study of the same patient. Except NCT most neuropsychological tests do not have validated parallel version 13,17,20,21 Neurophysiological tests like CFF analysis lack this draw back as response is based only on integrity of reflex arc & cortical functions. In our study repeat CFF analysis was performed on patients without MHE after 4 weeks showed no significant change over baseline, conforming lack of any learning effect.…”

Section: Assessment Of He Severitymentioning

confidence: 99%

Evaluation of Critical Flicker Frequency in Detecting and Monitoring Minimal Hepatic Encephalopathy

Rai¹,

Sharma²,

Chittawar³

et al. 2015

jemds

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BACKGROUND: Minimal hepatic encephalopathy (MHE) is defined as presence of abnormal neuropsychological and/or neurophysiological tests in cirrhotic patients without clinical signs of overt HE. Detecting MHE with available tests is time consuming, semi-objective, dependent on psychomotor skills of the patient and requires qualified personnel for administering test. Of late Critical Flicker Frequency (CFF) has emerged as a new diagnostic test for detecting MHE which obviates the above problem. AIM: To find out the prevalence of MHE in a group of adult cirrhotic patients with no overt HE, at a tertiary health care center using CFF analysis and assess changes in the same after four weeks of oral L-ornithine L-aspartate (LOLA) administration in subset with abnormal CFF. METHODS: 25 adult patients with cirrhosis, diagnosed on basis of clinical parameters & lab investigations, were invited to participate in the study. In patients without signs of overt encephalopathy (N=20) CFF analysis was done by HEPAtonorm analyzer. Cut off of 39 Hz was used, below which result was taken as abnormal and diagnostic of MHE. Patients with abnormal result (n=10) were given oral LOLA 30gm/day for 4 weeks. Repeat CFF analysis was done after 4 weeks in 13 patients, comprising 10 patients with abnormal and 3 patients with normal result in first study. Results were analyzed using non-parametric statistical tests. RESULTS: Of 20 patients without overt HE (M: F-12:8) (Median age 43 years [25-73yrs]) etiology was alcohol/cryptogenic/viral (B/C) in 4/7/9 (3/6), Child's status A/B/C in 5/7/8 respectively. The prevalence of MHE in cirrhotic patients was found to be 50% (10/20) and all of them had advanced cirrhosis (Child B/C). Subgroup of patients with MHE treated with LOLA for 4 weeks showed improvement in CFF test results repeated after 4 weeks (p=0.008) while those with no MHE showed insignificant change in their CFF after 4 weeks (p=0.85), signifying reproducibility & lack of learning effect. CONCLUSIONS: CFF measurement is a simple and reliable tool for detection of MHE. It also has high degree of reproducibility & lack of learning effect on repeated testing in the same patient. It provides an objective parameter for assessment of improvement in MHE by pharmacological intervention. CFF should be used more often to diagnose and monitor MHE in patients with advance cirrhosis.

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The number connection tests A and B: interindividual variability and use for the assessment of early hepatic encephalopathy

Cited by 122 publications

References 18 publications

Persistence of mild parkinsonism 4 months after liver transplantation in patients with preoperative minimal hepatic encephalopathy: a study on neuroradiological and blood manganese changes

Persistence of mild parkinsonism 4 months after liver transplantation in patients with preoperative minimal hepatic encephalopathy: a study on neuroradiological and blood manganese changes

Critical flicker frequency test for diagnosing minimal hepatic encephalopathy in patients with cirrhosis

Evaluation of Critical Flicker Frequency in Detecting and Monitoring Minimal Hepatic Encephalopathy

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