Evidence of persistent cognitive impairment after resolution of overt hepatic encephalopathy.
OBJECTIVE
The Inhibitory Control Test has been proposed as a tool to detect the persistence of cognitive defects after the resolution of overt hepatic encephalopathy (OHE). We tested learning abilities of cirrhotic patients using the Psychometric Hepatic Encephalopathy Score (PHES).


METHODS
One hundred six cirrhotic patients who agreed to be examined twice within 3 days were studied using the PHES. Twenty-seven patients had previous OHE; of the remaining 79 patients, 34 were affected by minimal HE and 45 were normal.


RESULTS
Among patients without previous OHE, PHESs significantly improved at the second examination; this learning effect was present in the patients with or without minimal HE. To the contrary, learning ability was lost in patients with previous OHE. Even among the 8 patients with history of HE and normal PHESs in the first examination, repeated testing showed a lack of learning capacity.


CONCLUSIONS
HE is not a fully reversible condition. Residual cognitive impairments should be evaluated by specific tests, based on patients' learning capacities.
Department of Clinical Medicine, Center for Diagnosis and Treatment of Portal Hypertension, Sapienza University of Rome, Rome, Italy. oliviero.riggio@uniroma1.it
Oliviero
O
Riggio
Lorenzo
L
Ridola
Chiara
C
Pasquale
Silvia
S
Nardelli
Ilaria
I
Pentassuglio
Federica
F
Moscucci
Manuela
M
Merli
D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006501:Hepatic Encephalopathy / Q000150:complications* / Q000628:therapy; D006801:Humans; D007859:Learning Disabilities / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests