Updating the neuropsychological test system in Japan for the elderly and in a modern touch screen tablet society by resetting the cut‐off values

Kawaguchi, Takumi; Konishi, Masaru; Kato, Akinobu; Kato, Masaaki; Kooka, Yohei; Sawara, Kei; Endo, Ryujin; Torimura, Takuji; Suzuki, Kazuyuki; Takikawa, Yasuhiro

doi:10.1111/hepr.12864

Cited by 22 publications

(42 citation statements)

References 23 publications

(52 reference statements)

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“…Neuropsychological functions were assessed by the NCT-B using neuropsychological test system software. The software was distributed by the Japan Society of Hepatology [19]. The hardware consisted of a touch screen tablet, such as an iPad (Apple, Cupertino, CA, USA).…”

Section: Neuropsychological Functionsmentioning

confidence: 99%

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Lower levels of serum albumin are associated with impairment of cognitive function in cirrhotic patients with early-stage hepatic encephalopathy: An exploratory data analysis of phase II/III clinical trials of rifaximin in Japan

Kaji¹,

Okita²,

Suzuki³

et al. 2020

Preprint

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Background Because covert hepatic encephalopathy (CHE) has been shown to affect the prognosis of cirrhotic patients, early diagnosis of HE is a prerequisite for preservation of patients’ quality of life and for prophylaxis of overt HE. Currently, neuropsychological tests are used for the diagnosis of early-stage HE including CHE. However, it would be inefficient to apply them to all cirrhotic patients. Thus, some biomarkers correlated with the above diagnostic modalities are available for screening examination. The aim of this study was to identify a clinical parameter to predict impairment of cognitive function in cirrhotic patients with early-stage HE.Methods This exploratory data analysis was based on the data from 172 patients with cirrhotic or idiopathic portosystemic shunt (PSS) in phase II/III trials of rifaximin in Japan. Their data at baseline before treatment with rifaximin were utilized to analyze the relationship between cognitive dysfunction and different clinical parameters We Classification and regression trees (CART) were constructed to identify clinical profiles related to cognitive dysfunction, as indicated by the prolongation of time required for the number connection test (NCT-B).Results CART analysis detected age 65 years as the variable for the initial split, and serum albumin level was selected as the variable for the second split among patients aged ≤ 65 years. In 27 cirrhotic patients aged ≤ 65 years without PSS, receiver-operating characteristic curve analysis revealed that the optimal albumin level cutoff point was 3.05 g/dL, and the area under the curve was 0.80 for the prolongation of NCT-B time, which was higher than that of other HE-related parameters including the branched-chain amino acids-to-tyrosine ratio (0.46), the prothrombin time–international normalized ratio (PT-INR) (0.68), serum ammonia (0.61), and total bilirubin (0.69).Conclusions Lower serum albumin level as a clinical biomarker associated with impaired cognitive function is available as a screening examination for early-stage HE in cirrhotic patients aged ≤ 65 years without PSS before undergoing neuropsychological tests.

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Section: Neuropsychological Functionsmentioning

confidence: 99%

“…The amount of prolongation of NCT-B time in the patients differed according to age: age < 45, 51. 1 [19]. ROC curve analysis obtained the optimal clinical profiles cutoff point.…”

Section: Receiver-operating Characteristic Curve Analysismentioning

confidence: 99%

Lower levels of serum albumin are associated with impairment of cognitive function in cirrhotic patients with early-stage hepatic encephalopathy: An exploratory data analysis of phase II/III clinical trials of rifaximin in Japan

Kaji¹,

Okita²,

Suzuki³

et al. 2020

Preprint

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“…As mentioned above, two diagnostic methods have been reported: proximal jejunal fluid cultivation and the breath test. Initially, SIBO was diagnosed by proximal jejunal fluid culture, but there are several limitations associated with this method, including the invasiveness of proximal jejunum fluid collection, the presence of nonculturable bacteria (approximately 60% of the intestinal microbiota) (25), and the possibility of oral bacterial contamination. In contrast, the breath test is easy to perform and is minimally invasive.…”

Section: Discussionmentioning

confidence: 99%

Small Intestinal Bacterial Overgrowth Diagnosed by a Breath Test and Improved by Rifaximin in a Patient with Hepatic Encephalopathy and Alcoholic Liver Cirrhosis

et al. 2020

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A 66-year-old Japanese man was admitted to our hospital with grade 2 hepatic encephalopathy (HE). Abdominal computed tomography and laboratory examinations revealed decompensated liver cirrhosis. Intravenous administration of branched-chain amino acids immediately ameliorated the HE, and lactulose was initiated. However, a breath test revealed small intestinal bacterial overgrowth (SIBO); therefore, rifaximin was additionally initiated. The breath test was repeated after discharge, when no evidence of SIBO or overt HE was identified. This case suggested that a breath test is effective for the identification of SIBO and that the administration of a poorly absorbed antibiotic should be considered in SIBO-positive HE patients taking lactulose.

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“…Neuropsychological functions were evaluated both before and 2 weeks after RFX treatment by means of NCT‐A and NCT‐B and the digit symbol test (DST) using neuropsychological test system software . The software is distributed by the Japan Society of Hepatology.…”

Section: Methodsmentioning

confidence: 99%

Rifaximin‐altered gut microbiota components associated with liver/neuropsychological functions in patients with hepatic encephalopathy: An exploratory data analysis of phase II/III clinical trials

Kawaguchi

Suzuki

Imamura³

et al. 2019

Hepatology Research

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AimsRifaximin (RFX), a non‐systemic antibiotic, improves liver/neuropsychological functions in patients with hepatic encephalopathy (HE). We aimed to investigate the clinical profiles associated with gut bacterial loads using exploratory data analysis and the effects of RFX on the gut microbiota of patients with HE.MethodsWe analyzed the data from 17 patients with HE who underwent fecal microbiota examination in phase II/III trials in Japan. Profiles associated with genera Streptococcus, Veillonella, and Lactobacillus loads were analyzed using classification and regression trees (CART). Changes in gut microbial consortia of seven patients with HE were then assessed 2 weeks after RFX treatment by principal component analysis.ResultsIn the CART, the first and second divergence variables for each higher bacterial load were as follows: (i) in Streptococcus, the number connection test‐A ≥39.55 s and presence of portal‐systemic shunt; (ii) in Veillonella, serum potassium levels <4.75 mEq/L and total cholesterol level <129.5 mg/dL; and (iii) in Lactobacillus, white blood cell counts ≥3.4 × 103/μL and aspartate aminotransferase level ≥44.5 U/L. There was no significant change in total bacterial load before and after RFX treatment; however, there was a decrease in Streptococcus, Veillonella, and Lactobacillus counts after RFX treatment.ConclusionWe report clinical profiles associated with gut bacterial loads in patients with HE, and showed that RFX altered gut microbiota components associated with liver/neuropsychological functions. Thus, RFX could improve liver/neuropsychological functions through the regulation of the gut microbial consortia in patients with HE.

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Updating the neuropsychological test system in Japan for the elderly and in a modern touch screen tablet society by resetting the cut‐off values

Abstract: We updated the NPT by covering subjects aged 40-79 years and resetting the cut-off values. Thus, the updated NPT is an elderly and modern subject-compliant application. This update may improve the diagnostic ability of covert hepatic encephalopathy in contemporary cirrhotic patients.

Cited by 22 publications

References 23 publications

Lower levels of serum albumin are associated with impairment of cognitive function in cirrhotic patients with early-stage hepatic encephalopathy: An exploratory data analysis of phase II/III clinical trials of rifaximin in Japan

Lower levels of serum albumin are associated with impairment of cognitive function in cirrhotic patients with early-stage hepatic encephalopathy: An exploratory data analysis of phase II/III clinical trials of rifaximin in Japan

Small Intestinal Bacterial Overgrowth Diagnosed by a Breath Test and Improved by Rifaximin in a Patient with Hepatic Encephalopathy and Alcoholic Liver Cirrhosis

Rifaximin‐altered gut microbiota components associated with liver/neuropsychological functions in patients with hepatic encephalopathy: An exploratory data analysis of phase II/III clinical trials

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