Normal Values for Psychometric Tests, for Kerala; and Its Evaluation in Cirrhotic Patients

Abstract

Background and Aim: Normal values of tests used for minimal hepatic encephalopathy (MHE), is dependent on education and age. In addition, it needs to be established for each society. Normal values for Kerala, South India, has not been established. The aim of the study is to establish normal values for each psychometric test used as part of MHE assessment for Kerala, South India and to use these to determine the prevalence of minimal hepatic encephalopathy in cirrhotic patients and to correlate with clinical parameters.Methods: MHE was assessed using Psychometric Hepatic Encephalopathy Score and critical flicker frequency in 68 controls and 82 cirrhotics. Multivariate linear regression was used to establish age, sex and education adjusted normal values for controls. With the new cut off values, MHE was reassessed in cirrhotic patients. Clinical parameters (edema, ascites, bilirubin and varices) were correlated to MHE.Results: Among controls, the psychometric tests, number connection test (NCT), figure connection test (FCT), digit symbol (DS), line tracing (LT) were dependent on age and education. None were independently correlated with sex. The linear correlations were: NCT = 42.5 + (age * 0.453) + (edu * −0.325), FCT = 54.8 + (age * 0.137) + (edu * −0.337), DS = 20.4 + (age * 0.532) + (edu * −0.289), LT = 112 + (age * 0.263) + (edu * −0.275). Serial dotting (SD) and critical flicker frequency (CFF) were not dependent on age or education. Upper limit of normal for SD was 83 s (55 + (2 * 14), M + (2 * SD)). These newly derived normal values were used to determine the presence of MHE in cirrhotics.Conclusion: Normal values for psychometric tests are defined by this study, for Kerala.Conflicts of InterestThe authors have none to declare. Background and Aim: Normal values of tests used for minimal hepatic encephalopathy (MHE), is dependent on education and age. In addition, it needs to be established for each society. Normal values for Kerala, South India, has not been established. The aim of the study is to establish normal values for each psychometric test used as part of MHE assessment for Kerala, South India and to use these to determine the prevalence of minimal hepatic encephalopathy in cirrhotic patients and to correlate with clinical parameters. Methods: MHE was assessed using Psychometric Hepatic Encephalopathy Score and critical flicker frequency in 68 controls and 82 cirrhotics. Multivariate linear regression was used to establish age, sex and education adjusted normal values for controls. With the new cut off values, MHE was reassessed in cirrhotic patients. Clinical parameters (edema, ascites, bilirubin and varices) were correlated to MHE. Results: Among controls, the psychometric tests, number connection test (NCT), figure connection test (FCT), digit symbol (DS), line tracing (LT) were dependent on age and education. None were independently correlated with sex. The linear correlations were: NCT = 42.5 + (age * 0.453) + (edu * −0.325), FCT = 54.8 + (age * 0.137) + (edu * −0.337), DS = 20.4 + (age * 0.532) + (edu * −0.289), LT = 112 + (age * 0.263) + (edu * −0.275). Serial dotting (SD) and critical flicker frequency (CFF) were not dependent on age or education. Upper limit of normal for SD was 83 s (55 + (2 * 14), M + (2 * SD)). These newly derived normal values were used to determine the presence of MHE in cirrhotics. Conclusion: Normal values for psychometric tests are defined by this study, for Kerala. Conflicts of InterestThe authors have none to declare. The authors have none to declare.