title: Minimal hepatic encephalopathy and extrapyramidal signs in patients with cirrhosis.
abstract: OBJECTIVE
  Two types of neurological dysfunction can occur in compensated cirrhosis: 1) extrapyramidal signs related to the accumulation of manganese in the basal ganglia and 2) milder degrees of cognitive impairment known as minimal hepatic encephalopathy (mHE). We assessed whether there was any relationship between both disorders in 42 patients with compensated cirrhosis.
  
  
  METHODS
  Minimal hepatic encephalopathy was diagnosed using a battery of manual neuropsychological tests. Cognitive functioning was assessed by the Mini-Mental State Examination. Extrapyramidal signs were evaluated by the Columbia scale.
  
  
  RESULTS
  Minimal hepatic encephalopathy was diagnosed in 15 (35.7%) patients. A total of 52.4% of patients showed significant extrapyramidal signs. Scores for the Columbia scale were higher in the presence of mHE (mean +/- SD, 16.0 +/- 10.9 vs 5.3 +/- 7.1, p = 0.0004). In the bivariate analysis, mHE, Child-Pugh score, and Mini-Mental State Examination score were significantly associated with extrapyramidal signs, whereas in the multivariate analysis, mHE was the only independent variable related to extrapyramidal signs.
  
  
  CONCLUSIONS
  There was a link between extrapyramidal signs and diagnosis of mHE based on manual neuropsychological testing. This finding may be explained by the influence of extrapyramidal manifestations on test performance or by a real pathophysiological relationship between both disorders. Further studies are necessary to resolve this question.
authors.affiliation: Service of Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Jover
authors.forename: Luís
authors.initials: L
authors.lastname: Compañy
authors.forename: Ana
authors.initials: A
authors.lastname: Gutiérrez
authors.forename: Pedro
authors.initials: P
authors.lastname: Zapater
authors.forename: Juan
authors.initials: J
authors.lastname: Pérez-Serra
authors.forename: Eva
authors.initials: E
authors.lastname: Girona
authors.forename: José R
authors.initials: JR
authors.lastname: Aparicio
authors.forename: Miguel
authors.initials: M
authors.lastname: Pérez-Mateo
mesh_terms: D000368:Aged; D001480:Basal Ganglia Diseases / Q000209:etiology*; D003071:Cognition; D005260:Female; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000523:psychology*; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D009483:Neuropsychological Tests; D012720:Severity of Illness Index