Despite the associated adverse outcomes, pharmacologic intervention for covert hepatic encephalopathy is not the standard of care.
Dr Jasmohan Bajaj and colleagues from Virginia, USA hypothesized that a video game-based rehabilitation program would improve white matter integrity and brain connectivity in the visuospatial network on brain magnetic resonance imaging (MRI).
The team assessed whether this would result in improved cognitive function in covert hepatic encephalopathy subjects on measures consistent with the cognitive skill set emphasized by the 2 video games, but also generalize to thinking skills beyond the focus of the cognitive training, and improve their health-related quality of life.
The research team performed a trial that included 3 phases over 8 weeks.
The first phase was the learning phase, during which cognitive tests were administered twice over 2 weeks without intervening intervention.
The second training phase included daily video game training for 4 weeks.
The third phase was the post-training phase, and consisted of testing 2 weeks after the video game training ended.
The researchers reported that 30 covert hepatic encephalopathy patients completed all visits with significant daily achievement on the video games.
In a subset of 13 subjects that underwent brain MRI, the team found a significant decrease in fractional anisotropy, and increased radial diffusivity involving similar brain regions, and improvement in the visuospatial resting-state connectivity corresponding to the video game training domains.
The team noted no significant corresponding improvement in health-related quality of life or HVLT performance was noted, but cognitive performance did transiently improve on cognitive tests similar to the video games during training.
Dr Bajaj's team comments, "Although multimodal brain imaging changes suggest reductions in tract edema and improved neural network connectivity, this trial of video game brain training did not improve the health-related quality of life or produce lasting improvement in cognitive function in patients with covert hepatic encephalopathy."