title: Can computerized brain training games be used to identify early cognitive impairment in cirrhosis?
abstract: OBJECTIVE
  We evaluated whether commercially available, computerized "brain-training" games can be used to identify subtle cognitive impairments in patients with cirrhosis.
  
  
  METHODS
  We compared patients with cirrhosis who did not have overt encephalopathy (n=31), patients with pre-cirrhotic chronic liver disease (n=28), and normal controls without liver disease (n=16) with respect to their scores on the number connection test-A (NCT-A), the Inhibitory Control Test (ICT), and five, short (∼2.5 min), brain-training games that were administered on an Apple iPad and tested different cognitive domains.
  
  
  RESULTS
  Patients with cirrhosis had similar scores to patients with pre-cirrhotic liver disease and slightly worse scores than normal controls in the NCT-A and the ICT, although these differences were not statistically significant. In contrast, patients with cirrhosis had significantly worse scores than patients with pre-cirrhotic liver disease and even more so than normal controls in all five of the brain-training games. After adjustment for age and educational attainment, these differences remained significant for two of the tests, "Color Match" which is a version of the Stroop test and measures selective attention, and "Memory Matrix", which measures visuospatial memory. The area under the receiver operating characteristic curve discriminating cirrhosis from pre-cirrhotic liver disease was 0.56 (95% confidence interval (CI) 0.41-0.72) for the ICT and 0.58 (95% CI 0.43-0.73) for the NCT-A, indicating no discrimination, while it was 0.75 (95% CI 0.63-0.87) for "Color Match" and 0.77 (95% CI 0.64-0.90) for "Memory Matrix", indicating good discrimination.
  
  
  CONCLUSIONS
  Short, brain-training games administered on an iPad can be used as psychometric tests to detect subtle cognitive impairments in patients with cirrhosis without overt encephalopathy that could not be detected by the NCT-A or the ICT.
authors.affiliation: 1] Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA [2] Joint first authors.
authors.forename: Erica V
authors.initials: EV
authors.lastname: Tartaglione
authors.affiliation: 1] Division of Gastroenterology, Department of Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA [2] Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington, USA [3] Joint first authors.
authors.forename: Mark
authors.initials: M
authors.lastname: Derleth
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Lei
authors.initials: L
authors.lastname: Yu
authors.affiliation: 1] Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA [2] Division of Gastroenterology, Department of Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA [3] Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: George N
authors.initials: GN
authors.lastname: Ioannou
mesh_terms: D000368:Aged; D003071:Cognition / Q000502:physiology; D003072:Cognition Disorders / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011581:Psychological Tests; D011594:Psychometrics / Q000379:methods*; D018910:Video Games