Diagnosis of Minimal Hepatic Encephalopathy of Cirrhotic Patients Using a Combination of Neuropsychiatric and Neurophysiological Tests

Abstract

Background: Minimal Hepatic Encephalopathy (MHE) is characterized by mild cognitive impairment, attention deficits, psychomotor slowing and impaired vasomotor and bimanual coordination. These non-evident symptoms can be revealed with neuro psycho metric and neuro physiological testing. Aim: to validate a comprehensive set of neuropsychiatric test battery in addition to the neuro physiological tests in detecting MHE. Patients and Methods: Thirty patients with liver cirrhosis and no clinical evidence of HE were selected for this study. Patients underwent laboratory screening, Neuropsychiatric and Neuro physiological tests. Results: Impairment of at least one psychometric test was documented in 50% of patients, with 50% abnormal NCTA, 46.7% abnormal DST and 40% abnormal LTT. VEP records showed prolonged P100 in 46.7% of patients with 40% prolongation of P100 in the right eye and 46.7% in the left eye. EEG recording was abnormal in 43.3% patients and the recorded abnormalities included; slow theta waves in 33% of patients, slow delta waves 10%, and 56% had normal EEG. Conclusion: The incidence of MHE can vary according to the strategy of diagnosis and while strict dependence on neuropsychiatric tests can diagnose MHE in 50% of patients, adopting a more strict policy that incorporate neuro physiological tests can limit the diagnosis 40% of patients. There is moderate concordance between neuropsychiatric and neurophysiologic tests.