title: Effects of common chronic medical conditions on psychometric tests used to diagnose minimal hepatic encephalopathy.
abstract: Many chronic medical conditions are accompanied by cognitive disturbances but these have only to a very limited extent been psychometrically quantified. An exception is liver cirrhosis where hepatic encephalopathy is an inherent risk and mild forms are diagnosed by psychometric tests. The preferred diagnostic test battery in cirrhosis is often the Continuous Reaction Time (CRT) and the Portosystemic Encephalopathy (PSE) tests but the effect on these of other medical conditions is not known. We aimed to examine the effects of common chronic (non-cirrhosis) medical conditions on the CRT and PSE tests. We studied 15 patients with heart failure (HF), 15 with end stage renal failure (ESRF), 15 with dysregulated type II diabetes (DMII), 15 with chronic obstructive pulmonary disease (COPD), and 15 healthy persons. We applied the CRT test, which is a 10-min computerized test measuring sustained attention and reaction time stability and the PSE test, which is a paper-pencil test battery consisting of 5 subtests. We found that a high fraction of the patients with HF (8/15, 0.002) or COPD (7/15, p = 0.006) had pathological CRT test results; and COPD patients also frequently had an abnormal PSE test result (6/15, p < 0.0001). Both tests were unaffected by ESRF and DMII. Half of the patients with HF or COPD had psychometrically measurable cognitive deficits, whereas those with ESRF or DMII had not. This adds to the understanding of the clinical consequences of chronic heart- and lung disease, and implies that the psychometric tests should be interpreted with great caution in cirrhosis patients with heart- or lung comorbidity.
authors.affiliation: Department of Gastroenterology, Hospital of South West Jutland, Finsensgade 35, 6700, Esbjerg, Denmark. mettelauridsen@gmail.com.
authors.forename: M M
authors.initials: MM
authors.lastname: Lauridsen
authors.affiliation: Department of Gastroenterology, Hospital of South West Jutland, Finsensgade 35, 6700, Esbjerg, Denmark.
authors.forename: L
authors.initials: L
authors.lastname: Poulsen
authors.affiliation: Department of Gastroenterology, Hospital of South West Jutland, Finsensgade 35, 6700, Esbjerg, Denmark.
authors.forename: C K
authors.initials: CK
authors.lastname: Rasmussen
authors.affiliation: Department of Gastroenterology, Hospital of South West Jutland, Finsensgade 35, 6700, Esbjerg, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Høgild
authors.affiliation: Department of Gastroenterology, Hospital of South West Jutland, Finsensgade 35, 6700, Esbjerg, Denmark.
authors.forename: M K
authors.initials: MK
authors.lastname: Nielsen
authors.affiliation: Department of Gastroenterology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
authors.forename: O B Schaffalitzky
authors.initials: OB
authors.lastname: de Muckadell
authors.affiliation: Department of Hepatology and Gastroenterology, Aarhus University Hospital, Nørrebrogade 44, 8200, Aarhus, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Vilstrup
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001288:Attention; D002908:Chronic Disease / Q000523:psychology; D003072:Cognition Disorders / Q000523:psychology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000523:psychology*; D005260:Female; D006501:Hepatic Encephalopathy / Q000175:diagnosis* / Q000523:psychology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011594:Psychometrics; D011930:Reaction Time; D055815:Young Adult
keywords: COPD; Comorbidity; Diabetes; Heart failure; Liver cirrhosis; Minimal hepatic encephalopathy; PHES; Reaction time; Renal failure