title: Extrapyramidal signs predict the development of overt hepatic encephalopathy in patients with liver cirrhosis.
abstract: OBJECTIVE
  The long-term evolution of cirrhotic patients with extrapyramidal signs has not yet been studied. We have investigated the influence of extrapyramidal signs on the prognosis, evolution, and quality of life of patients with liver cirrhosis.
  
  
  METHODS
  Forty-six patients with cirrhosis were followed up and 18 of them were reevaluated, a mean of 45 months later. Cognitive impairment was measured with psychometric tests (Trail-Making Test part A, Grooved-Pegboard, Block-Design, Oral Symbol Digit and Stroop Test). Extrapyramidal signs were evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS). Health-related quality of life was measured using the SF-36 scale and the Chronic Liver Disease Questionnaire.
  
  
  RESULTS
  Eleven of the 46 patients who were followed up developed overt hepatic encephalopathy (HE) during the follow-up. The presence of extrapyramidal signs was the unique factor that predicted overt HE and patients with basal higher score in the part 3 of the UPDRS developed overt HE more frequently [hazard ratio=1.29; 95% confidence interval (1.04-1.60) P=0.023]. In the 18 reevaluated patients, there was an increase in the score of the UPDRS part 3 after follow-up. There was a worsening in the score values of the block design and the Number Connection Test. In health-related quality of life scales, patients scored better in the area of mental health of the SF-36 scale. Patients with extrapyramidal signs persisted with worse scores in several items of the SF-36 scale and the Chronic Liver Disease Questionnaire.
  
  
  CONCLUSIONS
  The presence of extrapyramidal signs in patients with liver cirrhosis predicts the development of overt HE. These signs increased along the follow-up, and remain a bad influence on quality of life.
authors.affiliation: Unidad de Gastroenterología, Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Compañy
authors.forename: Pedro
authors.initials: P
authors.lastname: Zapater
authors.forename: Miguel
authors.initials: M
authors.lastname: Pérez-Mateo
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Jover
mesh_terms: D000368:Aged; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D018450:Disease Progression; D005116:Extrapyramidal Tracts / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006501:Hepatic Encephalopathy / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011379:Prognosis; D011594:Psychometrics; D011788:Quality of Life; D011795:Surveys and Questionnaires