title: The animal naming test: An easy tool for the assessment of hepatic encephalopathy.
abstract: Screening for hepatic encephalopathy (HE) that does not cause obvious disorientation or asterixis (minimal HE [MHE]/grade 1 HE) is important. We examined if the animal naming test (ANT1) (maximum number of animals listed in 1 minute) is useful in this context. In total, 208 healthy controls, 40 controls with inflammatory bowel disease, and 327 consecutive patients with cirrhosis underwent the ANT1. Patients were tested for MHE by the psychometric HE score, and 146 were assessed by electroencephalography; 202 patients were followed up regarding the occurrence of overt HE and death. In the healthy controls, ANT1was influenced by limited education (<8 years) and advanced age (>80 years, P < 0.001). Using an age and education adjusting procedure, the simplified ANT1(S-ANT1) was obtained. An S-ANT1of <10 animals was abnormal. Of the patients, 169 were considered unimpaired, 32 as having HE ≥grade 2, and 126 as having MHE/grade 1 HE. This group had lower S-ANT1than unimpaired patients (12 ± 0.4 versus 16 ± 0.7, P < 0.001) and higher S-ANT1than those with HE ≥grade 2 (4 ± 0.9). In grade 1 HE the S-ANT1was lower than in MHE. Following receiver operating characteristic analysis (Youden's index), 15 animals produced the best discrimination between unimpaired and MHE/grade 1 HE patients. Thus, a three-level score (0 for S-ANT1≥15, 1 for 10 ≤ S-ANT1< 15, 2 for S-ANT1<10) was obtained. This score was correlated both to the psychometric HE score (P < 0.0001) and to electroencephalography (P = 0.007). By sample random split validation, both S-ANT1and its three-level score showed prognostic value regarding the 1-year risk of overt HE and death. No inflammatory bowel disease control had S-ANT <15.
  
  
  
  The S-ANT1is an easily obtainable measure useful for the assessment of HE. (Hepatology 2017;66:198-208).
authors.affiliation: Department of Medicine DIMED and CIRMANMEC, University of Padua, Padua, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Campagna
authors.affiliation: Department of Medicine DIMED and CIRMANMEC, University of Padua, Padua, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Montagnese
authors.affiliation: Department of Gastroenterology, "La Sapienza" University, Rome, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Ridola
authors.affiliation: Multivisceral Transplant Unit, Department of Surgical and Gastroenterological Sciences, University of Padua, Padua, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Senzolo
authors.affiliation: Department of Medicine DIMED and CIRMANMEC, University of Padua, Padua, Italy.
authors.forename: Sami
authors.initials: S
authors.lastname: Schiff
authors.affiliation: Department of Medicine DIMED and CIRMANMEC, University of Padua, Padua, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: De Rui
authors.affiliation: Department of Gastroenterology, "La Sapienza" University, Rome, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Pasquale
authors.affiliation: Department of Gastroenterology, "La Sapienza" University, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Nardelli
authors.affiliation: Department of Gastroenterology, "La Sapienza" University, Rome, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Pentassuglio
authors.affiliation: Department of Medicine DIMED and CIRMANMEC, University of Padua, Padua, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Merkel
authors.affiliation: Department of Medicine DIMED and CIRMANMEC, University of Padua, Padua, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Angeli
authors.affiliation: Department of Gastroenterology, "La Sapienza" University, Rome, Italy.
authors.forename: Oliviero
authors.initials: O
authors.lastname: Riggio
authors.affiliation: Department of Medicine DIMED and CIRMANMEC, University of Padua, Padua, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Amodio
mesh_terms: D000328:Adult; D000818:Animals; D016022:Case-Control Studies; D018450:Disease Progression; D005260:Female; D006501:Hepatic Encephalopathy / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009275:Names; D009483:Neuropsychological Tests; D011379:Prognosis; D011446:Prospective Studies; D011594:Psychometrics; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index