The psychomotor vigilance task: Role in the diagnosis of hepatic encephalopathy and relationship with driving ability

Formentin, Chiara; Rui, Michele De; Zoncapè, Mirko; Ceccato, S; Zarantonello, Lisa; Senzolo, Marco; Burra, Patrizia; Angeli, Paolo; Amodio, Piero; Montagnese, Sara

doi:10.1016/j.jhep.2018.12.031

Cited by 16 publications

(12 citation statements)

References 60 publications

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“…This may suggest a connection between ammonia‐related NMDA‐type glutamate receptor dysfunction and astrocyte‐generated rhythmicity, and also offer a potential explanation to the decreased vigilance exhibited by patients with HE (Formentin et al. 2019) and evoked by induced hyperammonaemia (Bersagliere et al. 2012).…”

Section: The Astrocyte Circadian Clock In a Model Disorder: Hepatic Ementioning

confidence: 99%

The role of astrocytes in generating circadian rhythmicity in health and disease

Costa

2021

Journal of Neurochemistry

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Evidence is accumulating that the mammalian circadian clock system is considerably more complex than previously believed, also in terms of the cell types that actually contribute to generating the oscillation within the master clock, in the suprachiasmatic nuclei of the hypothalamus. Here we review the evidence that has lead to the identification of a bona fide astrocytic circadian clock, and that of the potential contribution of such clock to the generation of circadian and seasonal rhythmicity in health and in neurodegenerative disorders. Finally, we speculate on the role of the astrocytic clock in determining some of the clinical features of hepatic encephalopathy, a reversible neuropsychiatric syndrome associated with advanced liver disease, which is characterized by transient, profound morphological and functional astrocytic abnormalities, in the absence of significant, structural neuronal changes.

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Section: The Astrocyte Circadian Clock In a Model Disorder: Hepatic Ementioning

confidence: 99%

The role of astrocytes in generating circadian rhythmicity in health and disease

Costa

2021

Journal of Neurochemistry

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“…Approximately 30% of cirrhotic patients show MHE, which reduces the ability to perform tasks of daily life such as driving cars and increases the risk of suffering traffic, work and home accidents and the risk of falls, fractures and hospitalizations …”

Section: Introductionmentioning

confidence: 99%

“…Cirrhotic patients without evident symptoms of HE may present what is called covert or minimal hepatic encephalopathy (MHE), which includes psychomotor slowing, attention deficits, mild cognitive impairment and impaired visuo-motor coordination and can be revealed using specific psychometric tests. [3][4][5][6] Approximately 30% of cirrhotic patients show MHE, which reduces the ability to perform tasks of daily life such as driving cars and increases the risk of suffering traffic, [7][8][9] work and home accidents and the risk of falls, fractures and hospitalizations. 10 Minimal hepatic encephalopathy reduces quality of life and life span and increases the risk of progressing to more severe HE and to coma and death.…”

Section: Introductionmentioning

confidence: 99%

Peripheral inflammation induces neuroinflammation that alters neurotransmission and cognitive and motor function in hepatic encephalopathy: Underlying mechanisms and therapeutic implications

et al. 2019

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Several million patients with liver cirrhosis suffer minimal hepatic encephalopathy (MHE), with mild cognitive and coordination impairments that reduce their quality of life and life span. Hyperammonaemia and peripheral inflammation act synergistically to induce these neurological alterations. We propose that MHE appearance is because of the changes in peripheral immune system, which are transmitted to brain, leading to neuroinflammation that alters neurotransmission leading to cognitive and motor alterations. We summarize studies showing that MHE in cirrhotic patients is associated with alterations in the immune system and that patients died with HE show neuroinflammation in cerebellum, with microglial and astrocytic activation and Purkinje cell loss. We also summarize studies in animal models of MHE on the role of peripheral inflammation in neuroinflammation induction, how neuroinflammation alters neurotransmission and how this leads to cognitive and motor alterations. These studies identify therapeutic targets and treatments that improve cognitive and motor function. Rats with MHE show neuroinflammation in hippocampus and altered NMDA and AMPA receptor membrane expression, which impairs spatial learning and memory. Neuroinflammation in cerebellum is associated with altered GABA transporters and extracellular GABA, which impair motor coordination and learning in a Y maze. These alterations are reversed by treatments that reduce peripheral inflammation (anti‐TNFα, ibuprofen), neuroinflammation (sulphoraphane, p38 inhibitors), GABAergic tone (bicuculline, pregnenolone sulphate) or increase extracellular cGMP (sildenafil or cGMP). The mechanisms identified would also occur in other chronic diseases associated with inflammation, aging and some mental and neurodegenerative diseases. Treatments that improve MHE may also be beneficial to treat these pathologies.

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“…Thus, a case-by-case decision taking individual circumstances into account seems to be appropriate. Recently, the group of Amodio and Montagnese introduced a promising tool called the psychomotor vigilance task to judge driving ability in cirrhotic patients [19]. Since this tool needs multicenter validation in different countries, an examination by a driving instructor still seems to be the most reasonable recommendation for patients with CHE or history of OHE.…”

Section: Discussionmentioning

confidence: 99%

Management of hepatic encephalopathy in Germany: a survey among physicians

et al. 2020

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Background Hepatic encephalopathy (HE) is a severe complication of liver cirrhosis with impairment of quality of life and prognosis. Management patterns among physicians have not been investigated yet. Methods A questionnaire containing 17 questions was sent out to 1468 gastroenterologists and 120 general practitioners (GPs). It included questions regarding diagnostic, therapeutic, and management strategies used in patients with overt HE (OHE) and covert HE (CHE). Results The response rate was 12 % (n = 172) for gastroenterologists and 45 % (n = 54) for GPs. Of gastroenterologists, 26.7 % examine patients with an initial diagnosis of liver cirrhosis regarding HE. Gastroenterologists favored a combination of different testing strategies (27.9 %) and clinical examination (23.0 %), while the biggest part of the GPs use clinical examination (55.3 %); 63.7 % of gastroenterologists and 28.3 % of GPs give correct nutritional advices to patients with HE. Treatment strategies for acute bouts of OHE and secondary prophylaxis varied widely in both groups. Preferred medication was lactulose followed by rifaximin or a combination therapy. More than half of the GPs (53.7 %) were not familiar with minimal HE (MHE). About one-third of both groups never tried to diagnose MHE. Conclusion Our data strongly indicate that management of HE is very heterogeneous among gastroenterologists as well as selected GPs working in Germany and not driven by evidence-based international guidelines. Thus, the national guideline is more than welcome.

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The psychomotor vigilance task: Role in the diagnosis of hepatic encephalopathy and relationship with driving ability

Cited by 16 publications

References 60 publications

The role of astrocytes in generating circadian rhythmicity in health and disease

The role of astrocytes in generating circadian rhythmicity in health and disease

Peripheral inflammation induces neuroinflammation that alters neurotransmission and cognitive and motor function in hepatic encephalopathy: Underlying mechanisms and therapeutic implications

Management of hepatic encephalopathy in Germany: a survey among physicians

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