title: Motor dysfunction in patients with liver cirrhosis: impairment of handwriting.
abstract: Motor dysfunction is an important clinical finding in patients with liver cirrhosis and mild forms of hepatic encephalopathy. The mechanisms and clinical appearance of motor impairment in patients with liver cirrhosis are not completely understood. We studied fine motor control in forty four patients with advanced liver cirrhosis (excluding those with hepatic encephalopathy grade II) and 48 healthy controls using a kinematic analysis of standardized handwriting tests. We analysed parameters of velocity, the ability to coordinate and the level of automatisation of handwriting movements. Furthermore, we studied the association between impairment of handwriting and clinical neuro-psychiatric symptoms. As compared with control subjects, patients showed a statistically significant reduction of movement peak velocity in all handwriting tasks as well as a substantial increase of number of velocity inversions per stroke. Using a z-score based assessment we found impairment of handwriting in fourteen out of forty four patients (31.8 %). The deterioration of handwriting was associated with clinical symptoms of motor dysfunction, such as bradykinesia, adiadochokinesia, dysmetria of upper extremities and gait ataxia. This is the first study that quantitatively investigates impairment of handwriting in patients with liver cirrhosis. Our findings suggest the application of kinematic analysis of handwriting for diagnostics of motor dysfunction in patients with mild forms of hepatic encephalopathy.
authors.affiliation: Department of General Psychiatry, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria. s.mechtcheriakov@uibk.ac.at
authors.forename: Sergei
authors.initials: S
authors.lastname: Mechtcheriakov
authors.forename: Ivo W
authors.initials: IW
authors.lastname: Graziadei
authors.forename: André
authors.initials: A
authors.lastname: Kugener
authors.forename: Ingrid
authors.initials: I
authors.lastname: Schuster
authors.forename: Joerg
authors.initials: J
authors.lastname: Mueller
authors.forename: Hartmann
authors.initials: H
authors.lastname: Hinterhuber
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Vogel
authors.forename: Josef
authors.initials: J
authors.lastname: Marksteiner
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001696:Biomechanical Phenomena; D005260:Female; D006236:Handwriting; D006501:Hepatic Encephalopathy / Q000503:physiopathology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000209:etiology*; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics / Q000379:methods; D011597:Psychomotor Performance / Q000502:physiology*