Abstract
Background and Aims. Minimal hepatic encephalopathy (MHE) is diagnosed using neuropsychometric tests or neurophysiological tests that are either inapplicable to illiterate patient population in resource-poor settings or require sophisticated and expensive equipment. The available tests assess discrete domains of mental impairment. Our aim was (a) to design a neuropsychometric test that measures all domains of mental impairment in MHE using one metric; (b) to evaluate its sensitivity, specificity, and reproducibility. Methods. The mind and liver test (MALT), a psychometric test assessing cognition, memory, and psychometric impairment, each on a scale of 20, was designed keeping in mind the requirements of a universal test. 40 cirrhotics and 36 controls were subjected to critical flicker frequency (CFF) and MALT in same sitting. ROC curve was plotted for MALT using CFF as gold standard. Bland-Altman plot was used to find test-retest agreement. Results. CFF values and MALT scores varied significantly between the cases and the controls (P < 0.05). MALT was 94% sensitive and 83% specific. Using ROC with CFF as gold standard, the AUC for diagnosis of MHE using MALT score was 0.89. Test-retest agreement was high (ICC = 0.89). Conclusion. In this pilot study, MALT proved to be highly sensitive, specific, inexpensive, and reproducible.
Highlights
Hepatic encephalopathy is a major complication of cirrhosis
The highlights of the study are (a) a significant correlation between critical flicker frequency (CFF) and mind and liver test (MALT) scores in the population under study (P < 0.05); (b) the receiver-operating characteristic (ROC) curve and the box-whisker plots indicate that MALT is a highly sensitive and specific test considering CFF as the standard; and (c) the intraclass correlation coefficient was 0.894 on assessment of test-retest variability
The sensitivity and specificity of MALT was found to be 94% and 83%, respectively, compared to earlier reported 72.4% and 77.2% for CFF when the cut-off is set at 38 Hz [18]
Summary
Hepatic encephalopathy is a major complication of cirrhosis. It is characterized by neuropsychiatric manifestations. In minimal hepatic encephalopathy (MHE), patients have alterations in sleep pattern, and there is difficulty in performing even day-to-day routine activities like driving a vehicle, doing simple calculations, and so forth [1,2,3]. This is often due to an impairment in multiple faculties of the mind. Our aim was (a) to design a neuropsychometric test that measures all domains of mental impairment in MHE using one metric; (b) to evaluate its sensitivity, specificity, and reproducibility. MALT proved to be highly sensitive, specific, inexpensive, and reproducible
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