Journal of Hepatology
Volume 49, Issue 3 , Pages 346-353 , September 2008

Detection of minimal hepatic encephalopathy: Normalization and optimization of the Psychometric Hepatic Encephalopathy Score. A neuropsychological and quantified EEG study

  • Piero Amodio

      Affiliations

    • Department of Clinical and Experimental Medicine, Cirmanmec, University of Padua, Via Giustiniani, 2, 35128 Padua, Italy
    • Corresponding Author InformationCorresponding author. Tel.: +39 0498218677; fax: +39 0498754179.
  • ,
  • Francesca Campagna

      Affiliations

    • Department of Clinical and Experimental Medicine, Cirmanmec, University of Padua, Via Giustiniani, 2, 35128 Padua, Italy
  • ,
  • Stefania Olianas

      Affiliations

    • Department of General Psychology, Cirmanmec, University of Padua, Italy
  • ,
  • Pamela Iannizzi

      Affiliations

    • Department of General Psychology, Cirmanmec, University of Padua, Italy
  • ,
  • Daniela Mapelli

      Affiliations

    • Department of General Psychology, Cirmanmec, University of Padua, Italy
  • ,
  • Marco Penzo

      Affiliations

    • Department of General Psychology, Cirmanmec, University of Padua, Italy
  • ,
  • Paolo Angeli

      Affiliations

    • Department of Clinical and Experimental Medicine, Cirmanmec, University of Padua, Via Giustiniani, 2, 35128 Padua, Italy
  • ,
  • Angelo Gatta

      Affiliations

    • Department of Clinical and Experimental Medicine, Cirmanmec, University of Padua, Via Giustiniani, 2, 35128 Padua, Italy

Received 19 November 2007 ,Revised 28 March 2008 ,Accepted 22 April 2008.

References 

  1. Amodio P, Montagnese S, Gatta A, Morgan MY. Characteristics of minimal hepatic encephalopathy. Metab Brain Dis. 2004;19:253–267
  2. Lockwood AH. “What’s in a name?” Improving the care of cirrhotics. J Hepatol. 2000;32:859–861
  3. Amodio P, Del Piccolo F, Marchetti P, Angeli P, Iemmolo R, Caregaro L, et al. Clinical features and survival of cirrhotic patients with subclinical cognitive alterations detected by the number connection test and computerized psychometric tests. Hepatology. 1999;29:1662–1667
  4. Amodio P, Del Piccolo F, Petteno E, Mapelli D, Angeli P, Iemmolo R, et al. Prevalence and prognostic value of quantified electroencephalogram (EEG) alterations in cirrhotic patients. J Hepatol. 2001;35:37–45
  5. Saxena N, Bhatia M, Joshi YK, Garg PK, Dwivedi SN, Tandon RK. Electrophysiological and neuropsychological tests for the diagnosis of subclinical hepatic encephalopathy and prediction of overt encephalopathy. Liver. 2002;22:190–197
  6. Wein C, Koch H, Popp B, Oehler G, Schauder P. Minimal hepatic encephalopathy impairs fitness to drive. Hepatology. 2004;39:739–745
  7. Groeneweg M, Quero JC, De Bruijn I, Hartmann IJ, Essink-bot ML, Hop WC, et al. Subclinical hepatic encephalopathy impairs daily functioning. Hepatology. 1998;28:45–49
  8. Schomerus H, Hamster W. Quality of life in cirrhotics with minimal hepatic encephalopathy. Metab Brain Dis. 2001;16:37–41
  9. Amodio P, Marchetti P, Del Piccolo F, Campo G, Rizzo C, Iemmolo RM, et al. Visual attention in cirrhotic patients: a study on covert visual attention orienting. Hepatology. 1998;27:1517–1523
  10. Amodio P, Schiff S, Del Piccolo F, Mapelli D, Gatta A, Umilta C. Attention dysfunction in cirrhotic patients: an inquiry on the role of executive control, attention orienting and focusing. Metab Brain Dis. 2005;20:115–127
  11. Tarter RE, Hegedus AM, Van Thiel DH, Schade RR, Gavaler JS, Starzl TE. Non alcoholic cirrhosis associated with neuropsychological dysfunction in the absence of overt evidence of hepatic encephalopathy. Gastroenterology. 1984;86:1421–1427
  12. Weissenborn K, Giewekemeyer K, Heidenreich S, Bokemeyer M, Berding G, Ahl B. Attention, memory, and cognitive function in hepatic encephalopathy. Metab Brain Dis. 2005;20:359–367
  13. Weissenborn K, Heidenreich S, Ennen J, Ruckert N, Hecker H. Attention deficits in minimal hepatic encephalopathy. Metab Brain Dis. 2001;16:13–19
  14. Schiff S, Vallesi A, Mapelli D, Orsato R, Pellegrini A, Umilta C, et al. Impairment of response inhibition precedes motor alteration in the early stage of liver cirrhosis: a behavioral and electrophysiological study. Metab Brain Dis. 2005;20:381–392
  15. Schomerus H, Hamster W. Neuropsychological aspects of portal-systemic encephalopathy. Metab Brain Dis. 1998;13:361–377
  16. Weissenborn K, Ennen JC, Schomerus H, Ruckert N, Hecker H. Neuropsychological characterization of hepatic encephalopathy. J Hepatol. 2001;34:768–773
  17. Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT. Hepatic encephalopathy – definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 2002;35:716–721
  18. Lockwood AH, Murphy BW, Donnelly KZ, Mahl TC, Perini S. Positron-emission tomographic localization of abnormalities of brain metabolism in patients with minimal hepatic encephalopathy. Hepatology. 1993;18:1061–1068
  19. Douglass A, Al Mardini H, Record C. Amino acid challenge in patients with cirrhosis: a model for the assessment of treatments for hepatic encephalopathy. J Hepatol. 2001;34:658–664
  20. Romero-Gómez M, Cordoba J, Jover R, del Olmo J, Fernandez A, Flavia M, et al. Tablas de normalidad de la poblacion espanola para los tests psicometricos utilizados en el diagnostico de la encefalopatia hepatica minima. Med Clin (Barc). 2006;127:246–249
  21. Romero-Gómez M, Cordoba J, Jover R, del Olmo JA, Ramirez M, Rey R, et al. Value of the critical flicker frequency in patients with minimal hepatic encephalopathy. Hepatology. 2007;45:879–885
  22. Amodio P, Wenin H, Del Piccolo F, Mapelli D, Montagnese S, Pellegrini A, et al. Variability of trail making test, symbol digit test and line trait test in normal people. A normative study taking into account age-dependent decline and sociobiological variables. Aging Clin Exp Res. 2002;14:117–131
  23. Klem GH, Lüders HO, Jasper HH, Elger C. The ten–twenty electrode system of the International Federation. In:  Deuschal G,  Eisen A editor. Recommandations for the practice of clinical neurophysiology: guidelines of the international federation of clinical neurophysiology. Amsterdam: Elsevier; 1999;p. 3–6
  24. Amodio P, Marchetti P, Del Piccolo F, de Tourtchaninoff M, Varghese P, Zuliani C, et al. Spectral versus visual EEG analysis in mild hepatic encephalopathy. Clin Neurophysiol. 1999;110:1334–1344
  25. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–310
  26. Quero JC, Hartmann IJ, Meulstee J, Hop WC, Schalm SW. The diagnosis of subclinical hepatic encephalopathy in patients with cirrhosis using neuropsychological tests and automated electroencephalogram analysis. Hepatology. 1996;24:556–560
  27. Weissenborn K, Ruckert N, Hecker H, Manns MP. The number connection tests A and B: interindividual variability and use for the assessment of early hepatic encephalopathy. J Hepatol. 1998;28:646–653
  28. Amodio P, Quero JC, Del Piccolo F, Gatta A, Schalm SW. Diagnostic tools for the detection of subclinical hepatic encephalopathy: comparison of standard and computerized psychometric tests with spectral-EEG. Metab Brain Dis. 1996;11:315–327

 The authors declare that they do not have anything to disclose regarding funding from industries or conflict of interest with respect to this manuscript.

PII: S0168-8278(08)00352-8

doi: 10.1016/j.jhep.2008.04.022

Journal of Hepatology
Volume 49, Issue 3 , Pages 346-353 , September 2008