The Diagnosis of Subclinical Hepatic Encephalopathy in Patients With Cirrhosis Using Neuropsychological Tests and Automated Electroencephalogram Analysis

Abstract

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...

Minimal Hepatic Encephalopathy is an under Recognized Entity in Clinical Practice of Bangladeshi Physician

“…In our study the prevalence of minimal hepatic encephalopathy is 66% which is concordant with previous studies 8 . Some author consider it as an epidemic pathology 10 .…”

Small-Diameter Portacaval H-Graft Shunt: A Paradigm Shift Back to Surgical Shunting in the Management of Variceal Bleeding in Patients With Preserved Liver Function

“…Postoperatively, hepatic encephalopathy was monitored by clinical evaluation by our hepatologists and included routine Reitan trail testing. 16 Patients did not receive prophylactic dietary protein restriction or lactulose administration after SDPHG shunt placement. Management of postoperative hepatic encephalopathy involved the sequential use of lactulose, lactulose and neomycin, and lactulose and neomycin with dietary protein restriction, as necessary.…”

Prevalence and significance of neurocognitive dysfunction in hepatitis C in the absence of correlated risk factors†

“…MHE occurs only in the presence of cirrhosis and is associated with EEG and neuropsychological abnormalities similar to those reported in patients with HCV. [9][10][11][12] Several of the previous studies have included patients with cirrhosis, 4,6 and most of these have included individuals with a history of substance abuse and/or affective disturbance. Statistical control or inferential testing of these effects was typically done, although often not for all factors simultaneously.…”