Prevalence of abnormal psychometric tests and critical flicker frequency after clinical recovery of overt hepatic encephalopathy.
BACKGROUND
Abnormal psychometric tests are common in cirrhotic patients without overt encephalopathy. It may seriously impair the patient's daily functioning and quality of life. Prevalence of abnormal psychometric tests after the clinical recovery of overt encephalopathy has not been studied.


METHODS
Consecutive 80 patients (age, 44.5+/-9.8 yr; M: F 66:14) with hepatic encephalopathy (HE) who recovered and met inclusion criteria were evaluated for abnormal psychometric tests ( > 2 SD) and critical flicker frequency (CFF < 38 Hz). All patients underwent number connection tests-A and B, figure connection tests -A and B (if illiterate), digit symbol test, object assembly test, CFF and arterial ammonia after one month of clinical recovery of HE.


RESULTS
Prevalence of abnormal psychometric tests (> 2SD) was seen in 58 (72.5%) patients. [33 (66%) of 50 patients on lactulose and 25 (83%) of 30 patients not on lactulose, P = 0.12]. Arterial ammonia was significantly higher in patients with abnormal psychometric tests compared to patients without it (86.3+/-22.2 vs 50.4+/-11.5 mmol/l, P = 0.01). CFF was < 38 Hz in 50 patients (62.5%). Patients with > or =2 abnormal psychometric tests had CFF significantly lower than with normal psychometric tests (35.6+/-2.3 vs 40.7+/-2.4 Hz, P = 0.001). CFF sensitivity and specificity in diagnosing > or =2 abnormal psychometric tests was 82 and 83% respectively. CFF was significantly correlated with psychometric tests [NCT-A (-0.672, P = 0.001) and B (-0.743, P = 0.001), digit symbol test (-0.533, P = 0.001), object assembly test (-0.659, P =0.001) and arterial ammonia level (-0.385, P = 0.02)].


CONCLUSIONS
About 73% of patients who recovered from HE had abnormal psychometric tests ( > 2SD). CFF is a simple reliable tool to find out the presence of abnormal tests.
Department of Gastroenterology, G. B. Pant Hospital, New Delhi-110 002, India. drpraveen_sharma@yahoo.com
Praveen
P
Sharma
Barjesh Chander
BC
Sharma
Shiv Kumar
SK
Sarin
D000328:Adult; D018913:Event-Related Potentials, P300; D005260:Female; D005425:Flicker Fusion; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D007792:Lactulose / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D015995:Prevalence; D011594:Psychometrics; D020127:Recovery of Function; D012189:Retrospective Studies; D018709:Statistics, Nonparametric
D007792:Lactulose