Dr George Ioannou and colleagues from Washington, USA evaluated whether commercially available, computerized 'brain-training' games can be used to identify subtle cognitive impairments in patients with cirrhosis.
The researchers compared patients with cirrhosis who did not have overt encephalopathy, patients with pre-cirrhotic chronic liver disease, and normal controls without liver disease with respect to their scores on the number connection test-A (NCT-A), the Inhibitory Control Test (ICT), and 5, short (~2.5 min), brain-training games that were administered on an Apple iPad and tested different cognitive domains.
The team noted that patients with cirrhosis had similar scores to patients with pre-cirrhotic liver disease and slightly worse scores than normal controls in the NCT-A and the ICT, although these differences were not statistically significant.
|The area under the receiver operating characteristic curve was 0.56 for the ICT|
|American Journal of Gastroenterology|
The research team found that patients with cirrhosis had significantly worse scores than patients with pre-cirrhotic liver disease and even more so than normal controls in all 5 of the brain-training games.
After adjustment for age and educational attainment, these differences remained significant for 2 of the tests, 'Color Match' which is a version of the Stroop test and measures selective attention, and 'Memory Matrix', which measures visuospatial memory.
The area under the receiver operating characteristic curve discriminating cirrhosis from pre-cirrhotic liver disease was 0.56 for the ICT, and 0.58 for the NCT-A, indicating no discrimination, while it was 0.75 for 'Color Match' and 0.77 for 'Memory Matrix', indicating good discrimination.
Dr Ioannou's team commented, "Short, brain-training games administered on an iPad can be used as psychometric tests to detect subtle cognitive impairments in patients with cirrhosis without overt encephalopathy that could not be detected by the NCT-A or the ICT."