Psychomotor performance defects in cirrhotic patients without overt encephalopathy

Gilberstadt, S

doi:10.1001/archinte.140.4.519

Cited by 53 publications

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“…defects, yet have a normal mental and neurological status on One hundred and thirty-seven consecutive patients global clinical examination. [3][4][5][6][7][8][9][10][11][12][13] The prevalence of this subclin-(mean age 49 years, range 17-77) with cirrhosis without ical hepatic encephalopathy (SHE) has been reported to vary any clinical signs of encephalopathy, were screened for from 30% 13 to 84%, 11 depending on the tests and population SHE. In addition, the Child-Pugh score and the arterial used.…”

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confidence: 99%

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The diagnosis of subclinical hepatic encephalopathy in patients with cirrhosis using neuropsychological tests and automated electroencephalogram analysis

Quero¹

1996

Hepatology

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Hepatic encephalopathy (HE) is a serious complication of Neuropsychological tests used for the assessment of advanced liver disease and refers to neuropsychiatric abnorsubclinical hepatic encephalopathy (SHE) may overdimalities (such as disorders of personality, altered levels of agnose SHE because scores are usually not corrected for consciousness, impairment of intellectual function), and neuage. The aim of this study was to estimate the prevalence romuscular dysfunction (asterixis) because of liver insuffiof SHE using two easy administrable psychometric tests ciency. defects, yet have a normal mental and neurological status on One hundred and thirty-seven consecutive patients global clinical examination. [3][4][5][6][7][8][9][10][11][12][13] The prevalence of this subclin-(mean age 49 years, range 17-77) with cirrhosis without ical hepatic encephalopathy (SHE) has been reported to vary any clinical signs of encephalopathy, were screened for from 30% 13 to 84%, 11 depending on the tests and population SHE. In addition, the Child-Pugh score and the arterial used. blood ammonia were determined. Patients with concur-The neuropsychological defects found in SHE may have a rent use of alcohol, benzodiazepines or anti-epileptics negative effect on patients' daily life. 6,14 In addition, these were excluded.defects are considered to be a preclinical stage of clinical Fifty percent of the patients had an abnormal NCT manifest HE. 4,9,15 In view of the reported high incidence of according to the standard recommended procedure, in SHE in patients with cirrhosis and its possible impact on contrast only 7% of the patients had an abnormal NCT daily life, routine assessment of early stages of HE is recomwhen scores corrected for age were used. Combining the mended, 4,6,9,16 as this syndrome may be fully reversible with results of the spectral EEG and the psychometric tests treatment. 4,[17][18][19][20] However, the extensive neuropsychological corrected for age yielded a higher prevalence of SHE test batteries used in most studies (up to 21 different psycho-(23%) than when each test method was used alone (17% metric tests! 9 ), are not suitable for a fast routine screening vs. 10% abnormal, respectively). Severity of liver disease in an outpatient clinic. Conn 21 suggested to use the Number correlated with the presence of SHE, because the preva-Connection Test (NCT) as a sole psychometric test for quantilence of abnormal tests increased from 14% in Child-fying HE. Other investigators 4,9,12,13,22 have proposed to use a Pugh grade A to 45% in Child-Pugh grade B or C. Age combination of two to three psychometric tests as a diagnostic above 40 years and an elevated blood ammonia level screen for SHE. As neuropsychological performance is known were significant determinants related to an abnormal to be influenced by age, 23,24 education, 24 and repetitive test-EEG. We conclude that the NCT uncorrected for age ing, 21 several investigators have used neurophysiological markedly overdiagnoses SHE and, therefore, should not tools suc...

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confidence: 99%

“…Two psychometric tests with age-corrected normal values (NCT part A, 30 Symbol Digit Test 31 ) were selected to be used as a neuropsychological screen. These two tests are easy to administer, have a reported high sensitivity in detecting SHE, [3][4][5]8,9,12,13 and can be performed within 5 Pugh score was determined to assess the severity of the …”

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confidence: 99%

The diagnosis of subclinical hepatic encephalopathy in patients with cirrhosis using neuropsychological tests and automated electroencephalogram analysis

Quero¹

1996

Hepatology

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“…In fact, a relationship has already been found between albumin plasma level and mental derangement in cirrhotics (Gilberstadt, 1980, Schomerus et al, 1981.…”

Section: Neuropsychological Assessmentmentioning

confidence: 89%

“…(1978) suggested that the Wechsler Adult Intelligence Scale (WAIS) performance test, the Reitan-A and B tests, and choice reaction time to light and sound have the best diagnostic values . The usefulness of the WAIS performance group test was later confirmed by Gilberstadt et al (1980), who found that the most useful tests are the Digit Symbol and the Block Design tests . Also Tarter et al .…”

Section: Introductionmentioning

confidence: 92%

Diagnostic tools for the detection of subclinical hepatic encephalopathy: comparison of standard and computerized psychometric tests with spectral-EEG

et al. 1996

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The prevalence of subclinical hepatic encephalopathy (SHE) varies according to the diagnostic tool used in its detection . Since a standardised approach to the diagnosis of SHE is not yet available, we compared psychometric tests and EEG spectral analysis . On the same day 32 cirrhotic patients without overt hepatic encephalopathy and 18 controls were assessed by psychometric tests, both standard and computerized (CPT), and by EEG spectral analysis (EEG-SA) . The CPT, measuring reaction time (Rt) and errors (er), were Font, Choice), Choice2 and Scan test. The standard psychometric tests were the number connection test (NCT), the Reitan-B test, the Line Tracing Test [for time: LTT(t) and for errors : LTT(er)], and the Symbol Digit test (SD) . Both psychometric tests [Reitan-B test, LTT(er) and CPT but Font (Rt) and Choice2 (er)] and EEG-SA parameters [mean dominant frequency (MDF) and theta power (0%)] significantly correlated (p<0 .05) with albumin plasma levels . LTT(er), Scan, Font, Choicel and Choice2 were significantly related to 0% and MDF. There was no control with positive EEG-SA, though one control was positive with LTT(t) and with the number of errors made during Font and Scan tests . The percentage of cirrhotics with positive EEG-SA was 34% (C1 95% =19-53), while 9-66% were positive with psychometric tests, depending on the test considered . In spite of the correlation between neuropsychological and neurophysiological parameters, the diagnostic agreement between EEG-SA and each psychometric test was not high . In conclusion : 1) neurophysiological and neuropsychological impairment in cirrhotics without overt hepatic encephalopathy were found linked to each other and to hepatic dysfunction ; 2) psychometric tests were not sufficiently good predictors of EEG alterations ; therefore, neuropsychological tools can not substitute neurophysiological ones to detect CNS dysfunction in liver disease .

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“…11,12 This comprises a subset of cirrhotic patients who do not show clinically overt symptoms of HE, but display abnormal neuropsychologic and/or neurophysiologic findings indicative of cerebral dysfunction. 13 Importantly, there is some evidence that traditional treatments for overt HE also improve this minimal HE. 14 Accordingly, it may be reasonable to test drugs for efficacy in overt HE by first establishing their capacity to improve or reverse minimal HE.…”

Section: Commentsmentioning

confidence: 99%

Challenges of Designing Hepatic Encephalopathy Treatment Trials

2003

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Background/Aims: The efficacy and safety of rifaximin in comparison with lactitol in the treatment of hepatic encephalopathy was assessed in a prospective randomized, double-blind, doubledummy, controlled trial. Methods: A total of 103 patients with grade I-III acute hepatic encephalopathy were randomized to receive rifaximin (50 patients, 1200 mg/day) or lactitol (53 patients, 60 g/day) for 5-10 days. Changes in portal-systemic encephalopathy (PSE) index on entry and at the end of the study were used to evaluate the efficacy of the two therapies. Results: Both groups were comparable before treatment with regard to demographic data and characteristics of the hepatic encephalopathy episode. The global efficacy of both therapies was similar: 81.6% in the rifaximin group and 80.4% in the lactitol group showed improvement or total regression of the episode. A significantly better evolution of the PSE index was observed in the rifaximin group, due to a greater effect of rifaximin in two components of the index: EEG abnormalities and ammonia levels. No serious events related to either treatment were found during the study. Conclusions: Rifaximin may be considered a useful and safe alternative therapy to lactitol in the treatment of acute hepatic encephalopathy in cirrhosis.

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Psychomotor performance defects in cirrhotic patients without overt encephalopathy

Cited by 53 publications

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The diagnosis of subclinical hepatic encephalopathy in patients with cirrhosis using neuropsychological tests and automated electroencephalogram analysis

The diagnosis of subclinical hepatic encephalopathy in patients with cirrhosis using neuropsychological tests and automated electroencephalogram analysis

Diagnostic tools for the detection of subclinical hepatic encephalopathy: comparison of standard and computerized psychometric tests with spectral-EEG

Challenges of Designing Hepatic Encephalopathy Treatment Trials

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