Dr Jasmohan Bajaj and colleagues from Wisconsin compared tests to diagnose minimal hepatic encephalopathy in cirrhotic patients.
The investigative team compared the inhibitory control test to a simple/rapid test of attention, and a standard psychometric battery test.
The investigators also assessed the ability of the tests to predict development of overt hepatic encephalopathy.
|10% of patients developed overt hepatic encephalopathy|
|The American Journal of Gastroenterology|
The team assessed 50 nonalcoholic cirrhotic, and 50 age/educational-status-matched controls.
The participants were given inhibitory control tests, and standard psychometric tests in the same sitting.
The team considered performance impaired beyond 2 standard deviations of controls as minimal hepatic encephalopathy.
The investigators compared inhibitory control test results between controls and cirrhotics and within cirrhotics with or without minimal hepatic encephalopathy.
Receiver-operating characteristic analysis was used to study inhibitory control tests for minimal hepatic encephalopathy diagnosis.
The team reported that 20 subjects were administered standard psychometric battery and inhibitory control tests twice to assess test-retest reliability.
All cirrhotics were followed routinely for the development of overt hepatic encephalopathy.
The researchers found that cirrhotics performed worse than controls on standard psychometric battery and inhibitory control tests.
Using standard psychometric battery tests, the team observed that 39 cirrhotics had minimal hepatic encephalopathy.
The team noted that the inhibitory control test was administered faster than standard psychometric battery tests.
Cirrhotics with minimal hepatic encephalopathy had significantly higher lure compared with those without minimal hepatic encephalopathy.
The investigators found that cirrhotics with minimal hepatic encephalopathy had lower target response compared with those without minimal hepatic encephalopathy.
Area under the curve for receiver-operating characteristic for lures alone was 96%.
Lure and target responses were highly correlated between sessions showing high test-retest reliability.
The investigative team observed that 10% of patients developed overt hepatic encephalopathy.
All of these patients had been diagnosed with minimal hepatic encephalopathy using inhibitory control tests, and standard psychometric battery tests.
None of these patients with discordant results on standard psychometric battery developed overt hepatic encephalopathy.
Dr Bajaj's team concluded, “Inhibitory control test has good sensitivity/specificity for minimal hepatic encephalopathy diagnosis.”
“It is reliable and is equivalent to standard psychometric battery for predicting overt hepatic encephalopathy development.”