title: Simple tools for complex syndromes: a three-level difficulty test for hepatic encephalopathy.
abstract: BACKGROUND
  Despite the impact of hepatic encephalopathy on quality of life and prognosis, easily administered tests for its diagnosis are still lacking.
  
  
  OBJECTIVE
  To assess the usefulness of the Scan package, a three-level-difficulty computerised reaction time test, to diagnose varying degrees of hepatic encephalopathy.
  
  
  METHODS
  Sixty-one cirrhotic patients underwent clinical evaluation, paper-and-pencil psychometry and the Scan package; 32 healthy controls served as reference.
  
  
  RESULTS
  Twenty-nine patients were classified as unimpaired, 15 as having minimal and 17 as having overt hepatic encephalopathy. All healthy controls were able to complete the Scan package; in contrast, the number of patients who were able to complete three/two/one part decreased in parallel with the degree of encephalopathy (χ(2)=17, p=0.01). Reaction times in all three parts increased significantly with the severity of encephalopathy. However, the profile of increase was different [group: F(3,77)=26, p<0.0001; test: F(2,154)=277, p<0.0001; group×test: F(6,154)=7, p<0.0001], with different parts being more/less sensitive to varying degrees of encephalopathy.
  
  
  CONCLUSIONS
  The Scan package seems useful for the diagnosis of hepatic encephalopathy and covers a considerable portion of its spectrum of severity.
authors: Department of Medicine, University of Padova, Padova, Italy. sara.montagnese@unipd.it
authors: Sara
authors: S
authors: Montagnese
authors: Sami
authors: S
authors: Schiff
authors: Matteo
authors: M
authors: Turco
authors: Carlo Alberto
authors: CA
authors: Bonato
authors: Lorenzo
authors: L
authors: Ridola
authors: Angelo
authors: A
authors: Gatta
authors: Jean-Baptiste
authors: JB
authors: Nousbaum
authors: Oliviero
authors: O
authors: Riggio
authors: Carlo
authors: C
authors: Merkel
authors: Piero
authors: P
authors: Amodio
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D005260:Female; D006501:Hepatic Encephalopathy / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011594:Psychometrics / Q000295:instrumentation; D011930:Reaction Time