Psychometric Hepatic Encephalopathy Score for the detection of minimal hepatic encephalopathy in Korean patients with liver cirrhosis

Seo, Yeon Seok; Yim, Sun Young; Jung, Jin Yong; Kim, Chang Ha; Kim, Jin-Dong; Keum, Bora; An, Hyonggin; Yim, Hyung Joon; Lee, Hong Sik; Kim, Chang Duck; Ryu, Ho Sang; Um, Soon Ho

doi:10.1111/j.1440-1746.2012.07217.x

Cited by 39 publications

(57 citation statements)

References 21 publications

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“…In our analysis, single PHES components were strongly dependent on age and education of control subjects. These relationships were identified at significantly higher levels ( P = 0.0001 for almost all tests) than in Korean or Mexican validation studies and at similar levels as evaluated in Spain , Italy and UK . Because of these relationships, we applied age‐ and education‐adjusted normograms using stepwise regression models.…”

Section: Discussionmentioning

confidence: 82%

Normalization of the psychometric hepatic encephalopathy score in Polish population. A prospective, quantified electroencephalography study

Koziarska

Kotarska

Nowacki

et al. 2013

Liver International

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Section: Discussionmentioning

confidence: 82%

Normalization of the psychometric hepatic encephalopathy score in Polish population. A prospective, quantified electroencephalography study

Koziarska

Kotarska

Nowacki

et al. 2013

Liver International

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“…This was not ideal as thresholds which apply in one population do not necessarily apply in others (Amodio et al 1996). However, normative reference data are now available in Italy (Amodio et al 2008); Spain (Romero Gómez et al 2006); the United Kingdom (Marks et al 2008); Poland (Wunsch et al 2013); South Korea (Seo et al 2012); and Mexico (Duarte-Rojo et al 2011); in addition, the PHES battery has been adapted and validated for use in India by replacing the Number Connection Test B with Figure Connection Test A to overcome possible unfamiliarity with the English alphabet (Kurmi et al 2008).…”

Section: Requirements For Normative Reference Datamentioning

confidence: 95%

Qualifying and quantifying minimal hepatic encephalopathy

et al. 2015

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Minimal hepatic encephalopathy is the term applied to the neuropsychiatric status of patients with cirrhosis who are unimpaired on clinical examination but show alterations in neuropsychological tests exploring psychomotor speed/executive function and/or in neurophysiological variables. There is no gold standard for the diagnosis of this syndrome. As these patients have, by definition, no recognizable clinical features of brain dysfunction, the primary prerequisite for the diagnosis is careful exclusion of clinical symptoms and signs. A large number of psychometric tests/test systems have been evaluated in this patient group. Of these the best known and validated is the Portal Systemic Hepatic Encephalopathy Score (PHES) derived from a test battery of five paper and pencil tests; normative reference data are available in several countries. The electroencephalogram (EEG) has been used to diagnose hepatic encephalopathy since the 1950s but, once popular, the technology is not as accessible now as it once was. The performance characteristics of the EEG are critically dependent on the type of analysis undertaken; spectral analysis has better performance characteristics than visual analysis; evolving analytical techniques may provide better diagnostic information while the advent of portable wireless headsets may facilitate more widespread use. A large number of other diagnostic tools have been validated for the diagnosis of minimal hepatic encephalopathy including Critical Flicker Frequency, the Inhibitory Control Test, the Stroop test, the Scan package and the Continuous Reaction Time; each has its pros and cons; strengths and weaknesses; protagonists and detractors. Recent AASLD/EASL Practice Guidelines suggest that the diagnosis of minimal hepatic encephalopathy should be based on the PHES test together with one of the validated alternative techniques or the EEG. Minimal hepatic encephalopathy has a detrimental effect on the well-being of patients and their care-givers. It responds well to treatment with resolution of test abnormalities and the associated detrimental effects on quality of life, liver-related mortality and morbidity. Patients will only benefit in this way if they can be effectively diagnosed. Corporate efforts and consensus agreements are needed to develop effective diagnostic algorithms.

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“…MHE is usually diagnosed by neuropsychological tests with at least 2 of the following neuropsychological tests: 30 a battery using number connection test (NCT) A and B, blockdesign test, and digit‐symbol test or a standardized test battery including NCT A and B, line‐tracing test, serial‐dotting test, and digit‐symbol test (PSE‐Syndrome‐Test). Although equipment is required, quantitative neurophysiological tools such as electroencephalography with mean dominant frequency, P300 auditory evoked potentials are also recommended 30 , 34 – 40 …”

Section: Diagnosis Of Hementioning

confidence: 99%

Effects of Oral Branched‐Chain Amino Acids on Hepatic Encephalopathy and Outcome in Patients With Liver Cirrhosis

2013

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Branched-chain amino acids (BCAAs) constituting of valine, leucine, and isoleucine act as both substrates of proteins and as key regulators for various nutrient metabolisms. Patients with liver cirrhosis frequently lack sufficient BCAAs and therefore suffer from various metabolic disorders. Hepatic encephalopathy (HE) is a severe metabolic disorder with neurologic manifestations such as flapping tremors and coma in patients with liver cirrhosis. In addition, a mild form of HE known as minimal HE (MHE) is an important social issue because it occurs in up to 80% of patients with chronic liver disease and affects prognosis and activities of daily living, possibly resulting in falls and motor vehicle accidents. Although HE/MHE can be caused by various pathological conditions, including in an accumulation of mercaptans, short-chain fatty acids, and alterations in the gut flora, hyperammonemia has also been implicated in an important pathogenesis of HE/MHE. Besides urea cycle of liver, ammonia can be detoxified in the skeletal muscles by the amidation process for glutamine synthesis using BCAAs. Thus, BCAA supplementation may enhance detoxification of ammonia in skeletal muscle and may be a possible therapeutic strategy for HE/MHE. In this review, we summarize the clinical impacts of BCAA supplementation on HE/MHE and discuss possible mechanisms for a BCAA-induced improvement of HE/MHE. Furthermore, we present some modifications of oral BCAA therapy for improvement of efficacy in HE treatment. We also briefly describe pleiotropic benefits of BCAAs on life-threatening events and overall prognosis in patients with liver cirrhosis.

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Psychometric Hepatic Encephalopathy Score for the detection of minimal hepatic encephalopathy in Korean patients with liver cirrhosis

Abstract: The PHES was useful for detecting patients with MHE. A significant proportion of Korean patients with liver cirrhosis suffer from MHE.

Cited by 39 publications

References 21 publications

Normalization of the psychometric hepatic encephalopathy score in Polish population. A prospective, quantified electroencephalography study

Normalization of the psychometric hepatic encephalopathy score in Polish population. A prospective, quantified electroencephalography study

Qualifying and quantifying minimal hepatic encephalopathy

Effects of Oral Branched‐Chain Amino Acids on Hepatic Encephalopathy and Outcome in Patients With Liver Cirrhosis

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