Abstract
Background: Psychometric testing is used to identify patients with cirrhosis who have developed hepatic encephalopathy (HE). Most batteries consist of a series of paper-and-pencil tests, which are cumbersome for most clinicians. A modern, easy-to-use, computer-based battery would be a helpful clinical tool, given that in its minimal form, HE has an impact on both patients quality of life and the ability to drive and operate machinery (with societal consequences). Aim: We compared the Cogstate computer battery testing with the Psychometric Hepatic Encephalopathy Score (PHES) tests, with a view to simplify the diagnosis. Methods: This was a prospective study of 27 patients with histologically proven cirrhosis. An analysis of psychometric testing was performed using accuracy of task performance and speed of completion as primary variables to create a correlation matrix. A stepwise linear regression analysis was performed with backward elimination, using analysis of variance. Results: Strong correlations were found between the international shopping list, international shopping list delayed recall of Cogstate and the PHES digit symbol test. The Shopping List Tasks were the only tasks that consistently had P values of <0.05 in the linear regression analysis. Conclusion: Subtests of the Cogstate battery correlated very strongly with the digit symbol component of PHES in discriminating severity of HE. These findings would indicate that components of the current PHES battery with the international shopping list tasks of Cogstate would be discriminant and have the potential to be used easily in clinical practice.
Highlights
Hepatic encephalopathy (HE) is one of the most debilitating consequences of liver disease and is characterized as diffuse brain dysfunction caused by liver insufficiency and/or portosystemic shunting.[1]
Each had blood drawn for standard liver biochemistry with Child–Pugh and United Kingdom end-stage liver disease scores being calculated to grade the functional level of cirrhosis for each patient.[15,16]
The highest correlation between test scores was observed for Cogstate’s International shopping list (ISL) and Psychometric Hepatic Encephalopathy Score (PHES)’ Serial Dotting task (ρ=0.51), followed by Identification test (IDN) and Line Tracing Time (ρ 0.45) (Figure 1). Another high correlation magnitude was observed for both the Cogstate ISL and International shopping list delayed recall (ISLR) with PHES digital symbol task (ρ=0.42 and 0.41, respectively)
Summary
Hepatic encephalopathy (HE) is one of the most debilitating consequences of liver disease and is characterized as diffuse brain dysfunction caused by liver insufficiency and/or portosystemic shunting.[1]. Psychometric testing is used to identify patients with cirrhosis who have developed hepatic encephalopathy (HE). Aim: We compared the CogstateTM computer battery testing with the Psychometric Hepatic Encephalopathy Score (PHES) tests, with a view to simplify the diagnosis. Conclusion: Subtests of the Cogstate battery correlated very strongly with the digit symbol component of PHES in discriminating severity of HE. These findings would indicate that components of the current PHES battery with the international shopping list tasks of Cogstate would be discriminant and have the potential to be used in clinical practice.
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