title: Rapid identification system of frontal dysfunction in subclinical hepatic encephalopathy.
abstract: Introduction and aim. Liver disease is associated with cognitive dysfunction also at early stages, and minimal hepatic encephalopathy, affecting 20-70% of patients, is frequently under-recognized. The main purpose of this work was to demonstrate that a substantial number of patients, enrolled due to an acute confusional state in absence of a diagnosis of liver disease, suffers of hepatic encephalopathy.
  
  
  METHODS
  Before a diagnosis of a well-compensated liver diseases was performed, 410 patients with an acute confusional state were enrolled in this study.
  
  
  RESULTS
  Even in the presence of minimal alterations of hepatic function, the psychometric tests applied demonstrated early signs of cerebral frontal alteration. The alteration was associated with the severity of liver disease, paralleling the progression of the patient to minimal hepatic failure or chronic liver disease.
  
  
  CONCLUSIONS
  These psychometric tests are essential to detect early and subclinical frontal failure. Frontal dysfunction may be a useful tool in the follow-up of these patients.
authors.affiliation: Neurology Clinic, Department of Medical, Surgical, and Health Sciences, University of Trieste, Trieste, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Moretti
authors.affiliation: Italian Liver Foundation, Centro Studi Fegato, Trieste, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Gazzin
authors.affiliation: Italian Liver Foundation, Centro Studi Fegato, Trieste, Italy; Liver Center, Department of Medical Sciences, University of Trieste, Trieste.
authors.forename: Lory Saveria
authors.initials: LS
authors.lastname: Crocè
authors.affiliation: Neurology Clinic, Department of Medical, Surgical, and Health Sciences, University of Trieste, Trieste, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Baso
authors.affiliation: Italian Liver Foundation, Centro Studi Fegato, Trieste, Italy; Liver Center, Department of Medical Sciences, University of Trieste, Trieste.
authors.forename: Flora
authors.initials: F
authors.lastname: Masutti
authors.affiliation: Italian Liver Foundation, Centro Studi Fegato, Trieste, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bedogni
authors.affiliation: Italian Liver Foundation, Centro Studi Fegato, Trieste, Italy; Liver Center, Department of Medical Sciences, University of Trieste, Trieste.
authors.forename: Claudio
authors.initials: C
authors.lastname: Tiribelli
mesh_terms: D000328:Adult; D057565:Apathy; D001288:Attention; D001364:Awareness; D001519:Behavior; D016022:Case-Control Studies; D003221:Confusion / Q000175:diagnosis / Q000523:psychology*; D056344:Executive Function; D005260:Female; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000523:psychology*; D006801:Humans; D007600:Judgment; D008103:Liver Cirrhosis / Q000523:psychology*; D008107:Liver Diseases / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011594:Psychometrics