A pilot evaluation of a computer-based psychometric test battery designed to detect impairment in patients with cirrhosis

Abstract

BackgroundPsychometric testing is used to identify patients with cirrhosis who have developed hepatic encephalopathy (HE). Most batteries consist of a series of paper-and-pencil tests, which are cumbersome for most clinicians. A modern, easy-to-use, computer-based battery would be a helpful clinical tool, given that in its minimal form, HE has an impact on both patients’ quality of life and the ability to drive and operate machinery (with societal consequences).AimWe compared the Cogstate™ computer battery testing with the Psychometric Hepatic Encephalopathy Score (PHES) tests, with a view to simplify the diagnosis.MethodsThis was a prospective study of 27 patients with histologically proven cirrhosis. An analysis of psychometric testing was performed using accuracy of task performance and speed of completion as primary variables to create a correlation matrix. A stepwise linear regression analysis was performed with backward elimination, using analysis of variance.ResultsStrong correlations were found between the international shopping list, international shopping list delayed recall of Cogstate and the PHES digit symbol test. The Shopping List Tasks were the only tasks that consistently had P values of <0.05 in the linear regression analysis.ConclusionSubtests of the Cogstate battery correlated very strongly with the digit symbol component of PHES in discriminating severity of HE. These findings would indicate that components of the current PHES battery with the international shopping list tasks of Cogstate would be discriminant and have the potential to be used easily in clinical practice.

Altered intrinsic brain activity in patients with hepatic encephalopathy

“…Furthermore, we found a negative correlation between brain activity in the left ACC and the complete time of NCT‐A, a neuropsychological test measuring concentration, mental tracking, and audio‐visuomotor functions (Cook et al., 2017). This finding indicates that brain activity abnormalities in the left ACC can reflect neurobehavioral deficits in LC patients.…”

“…Furthermore, we found a negative correlation between brain activity in the left ACC and the complete time of NCT-A, a neuropsychological test measuring concentration, mental tracking, and audio-visuomotor functions (Cook et al, 2017 has revealed that aberrant brain activity at resting state may be involved in neurocognitive impairments in low-grade HE patients, through measuring cerebral glucose metabolism by PET (Lockwood et al, 2002). Thus, our meta-analysis might provide reliable imaging biomarker for a better understanding of the pathophysiological mechanisms of HE, and provide potential therapeutic targets.…”

“…The NCT‐A and DST are useful tools for the diagnosis of HE that were proposed by the World Congress of Gastroenterology in 1998 and have been demonstrated to have high specificity for HE (Ferenci et al., 2002; Weissenborn et al., 2001). The NCT‐A is widely used to measure concentration, mental tracking, and audio‐visuomotor speed, and the DST is mainly used to measure psychomotor and visuomotor speed (Cook et al., 2017). The statistical significance was based on Monte Carlo randomizations.…”

Abnormal brain functional networks in end‐stage renal disease patients with cognitive impairment

“…Moreover, our further partial correlation analysis results of the CI group also support these findings partially, which revealed that the completion time of TMT‐A was negatively correlated with nodal degree in the left PCG, and SDMT scores were positively related to nodal efficiency in the bilateral SFGmed and right PCUN. Notably, TMT‐A and SDMT are neuropsychological tests that evaluate cognitive domains in concentration, mental tracking, visuomotor speed, psychomotor speed, attention, and visual memory (Cook et al., 2017).…”

Interpretable Machine Learning Models for Three-Way Classification of Cognitive Workload Levels for Eye-Tracking Features

“…The digit symbol substitution test (DSST) [31] is a cognitive tool introduced as a paper-and-pencil test originally applied in order to understand human associative learning. Currently, this test is commonly applied in clinical neuropsychology to measure cognitive dysfunction and is often present in cognitive and neuropsychological test batteries [32,33]. The DSST allows one to check the patient's processing speed, memory, and executive functioning [34].…”