title: Inhibitory control test for the diagnosis of minimal hepatic encephalopathy.
abstract: OBJECTIVE
  Minimal hepatic encephalopathy (MHE) is difficult to diagnose. The Inhibitory Control Test (ICT) measures response inhibition and has diagnosed MHE with 90% sensitivity and specificity in a selected population; high lure and low target rates indicated poor ICT performance. We studied the reliability and validity of ICT for MHE diagnosis.
  
  
  METHODS
  ICT was compared with a psychometric battery (standard psychometric tests [SPT]) for MHE diagnosis and overt hepatic encephalopathy (OHE) prediction. ICT was administered twice for test-retest reliability, before/after transvenous intrahepatic portosystemic shunting (TIPS), and before/after yogurt treatment. The time taken by 2 medical assistants (MA) to administer ICT was recorded and compared with that of a psychologist for cost analysis.
  
  
  RESULTS
  One hundred thirty-six cirrhotic patients and 116 age/education-matched controls were studied. ICT (>5 lures) had 88% sensitivity for MHE diagnosis with 0.902 area under the curve for receiver operating characteristic. MHE-positive patients had significantly higher ICT lures (11 vs 4, respectively, P = .0001) and lower targets (92% vs 97%, respectively, P = .0001) compared with MHE-negative patients. The test/retest reliability for ICT lures (n = 50, r = 0.90, P = .0001) was high. ICT and SPT were equivalent in predicting OHE (21%). ICT lures significantly worsened after TIPS (n = 10; 5 vs 9, respectively; P = .02) and improved after yogurt supplementation (n = 18, 10 vs 5, respectively; P = .002). The MAs were successfully trained to administer ICT; the time required for test administration and the associated costs were smaller for ICT than for SPT.
  
  
  CONCLUSIONS
  ICT is a sensitive, reliable, and valid test for MHE diagnosis that can be administered inexpensively by MAs.
authors: Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA. jasmohan.bajaj@va.gov
authors: Jasmohan S
authors: JS
authors: Bajaj
authors: Muhammad
authors: M
authors: Hafeezullah
authors: Jose
authors: J
authors: Franco
authors: Rajiv R
authors: RR
authors: Varma
authors: Raymond G
authors: RG
authors: Hoffmann
authors: Joshua F
authors: JF
authors: Knox
authors: Darrell
authors: D
authors: Hischke
authors: Thomas A
authors: TA
authors: Hammeke
authors: Steven D
authors: SD
authors: Pinkerton
authors: Kia
authors: K
authors: Saeian
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001288:Attention / Q000502:physiology*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006501:Hepatic Encephalopathy / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010045:Outpatients; D011594:Psychometrics / Q000379:methods*; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult