scholarly journals Normalisation of the psychometric encephalopathy score within the Cameroonian population

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Larissa Pessidjo Djomatcho ◽  
Mathurin Pierre Kowo ◽  
Antonin Ndjitoyap Ndam ◽  
Sylvain Raoul Simeni Njonnou ◽  
Gabin Ulrich Kenfack ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Healthy Volunteers ◽  
Clinical Signs ◽  
Minimal Hepatic Encephalopathy ◽  
Education Level ◽  
Multicentric Study ◽  
Tracing Test ◽  
Cirrhotic Patients ◽  
The Mean ◽  
Number Connection Test

Abstract Background Minimal hepatic encephalopathy (MHE) is the presence of neuropsychological abnormalities detectable by psychometric tests. Psychometric Hepatic Encephalopathy Score (PHES) is a gold standard test for the early diagnosis of MHE in cirrhotic patients. The aim of this study was to standardize the PHES in a healthy Cameroonian population and to evaluate the prevalence of MHE among cirrhotic patients. Methods This was a prospective, multicentric study from 1 December 2018 to 31 July 2019 in two groups: healthy volunteers and cirrhotic patients without clinical signs of hepatic encephalopathy. The results of the number connection test-A, number connection test-B, serial dotting test, line tracing test were expressed in seconds and those of the digit symbol test in points. Results A total of 102 healthy volunteers (54 men, 48 women) and 50 cirrhotic patients (29 men, 31 women) were included. The mean age was 38.1 ± 12.55 years in healthy volunteers and 49.3 ± 15.6 years in cirrhotic patients. The mean years of education level was 11.63 ± 4.20 years in healthy volunteers and 9.62 ± 3.9 years in cirrhotic patients. The PHES of the healthy volunteer group was − 0.08 ± 1.28 and the cut-off between normal and pathological values was set at − 3 points. PHES of the cirrhotic patients was − 7.66 ± 5.62 points and significantly lower than that of volunteers (p < 0.001). Prevalence of MHE was 74% among cirrhotic patients. Age and education level were associated with MHE. Conclusion PHES cut-off value in Cameroonians is − 3, with MHE prevalence of 74% among cirrhotic patients.

scholarly journals Normalization of the Psychometric Encephalopathy Score in Cameroonian Population

2020 ◽  
Author(s):  
Larissa Pessidjo Djomatcho ◽  
Mathurin Kowo ◽  
Antonin Ndjitoyap Ndam ◽  
Sylvain Raoul Simeni Njonnou ◽  
Gabin Ulrich Kenfack ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Healthy Volunteers ◽  
Clinical Signs ◽  
Minimal Hepatic Encephalopathy ◽  
Education Level ◽  
Multicentric Study ◽  
Tracing Test ◽  
Cirrhotic Patients ◽  
The Mean ◽  
Number Connection Test

Abstract Background: Minimal hepatic encephalopathy (MHE) is the presence of neuropsychological abnormalities detectable by psychometric tests. Psychometric Hepatic Encephalopathy Score (PHES) is a gold standard test for the early diagnosis of MHE in cirrhotic patients. Aim: To standardize the PHES in a healthy Cameroonian population and to evaluate the prevalence of MHE among cirrhotic patients. Methods: This was a prospective, multicentric study from December 1st, 2018 to July 31st, 2019 in two groups: healthy volunteers and cirrhotic patients without clinical signs of hepatic encephalopathy. The results of the Number Connection Test-A (NCT-A), Number Connection Test-B (NCT-B), Serial Dotting Test (SDT), Line Tracing Test (LTT) were expressed in seconds and those of the Digit Symbol Test (DST) in points. Results: A total of 102 healthy volunteers (54 men, 48 women) and 50 cirrhotic patients (29 men, 31 women) were included. The mean age was 38.1 ± 12.55 years in healthy volunteers and 49.3±15.6 years in cirrhotic patients. The mean years of education level was 11.63 ± 4.20 years in healthy volunteers and 9.62±3,9 years in cirrhotic patients. The PHES of the healthy volunteer group was -0.08 ± 1.28 and the cut-off between normal and pathological values was set at −3 points. PHES of the cirrhotic patients was -7.66 ± 5.62 points and significantly lower than that of volunteers (p <0.001). Prevalence of MHE was 74% among cirrhotic patients. Age and education level were associated with MHE.Conclusion: PHES cut-off value in Cameroonians is -3, with MHE prevalence of 74% among cirrhotic patients.

scholarly journals Minimal Hepatic Encephalopathy: The Reality Beyond Our Eyes

2015 ◽  
Vol 28 (4) ◽  
pp. 480 ◽  
Author(s):  
Mara Barbosa ◽  
Carla Marinho ◽  
Paula Mota ◽  
José Cotter
Keyword(s):  
Liver Disease ◽  
Hepatic Encephalopathy ◽  
Venous Blood ◽  
Minimal Hepatic Encephalopathy ◽  
Ammonia Concentration ◽  
Meld Score ◽  
Published Data ◽  
Cross Sectional ◽  
Cirrhotic Patients ◽  
The Mean

<p><strong>Introduction: </strong>Minimal hepatic encephalopathy refers to a mild neurocognitive impairment not detectable by clinical examination that can be present in cirrhotic patients.<br /><strong>Aim:</strong> To determine the prevalence of minimal hepatic encephalopathy in a secondary healthcare center in Northern Portugal.<br /><strong>Material and Methods:</strong> A cross-sectional study was conducted. Cirrhotic outpatients were included. Exclusion criteria: overt hepatic encephalopathy, illiteracy, active alcohol consumption, psychotropic drug use and therapy with lactulose. The presence of minimal hepatic encephalopathy was defined as a value ≤ -4 on the Psychometric Hepatic Encephalopathy Score, calculated according to the Portuguese norms. Variables analyzed: etiology and severity of liver disease and venous blood ammonia concentration. p values &lt;<br />0.05 were considered significant.<br /><strong>Results: </strong>From the 102 patients who were evaluated, 41 were included: 31 males, mean age 57 ± 10 years, mean education 5 ± 2 years, 31 in Child-Pugh class A, mean MELD score 6 ± 3. Minimal hepatic encephalopathy was diagnosed in 14 (34%) patients. The presence of minimal hepatic encephalopathy was unrelated to severity of liver disease. Despite being more elevated, the mean venous ammonia concentration in minimal hepatic encephalopathy patients was not statistically different from the mean venous ammonia concentration in non-minimal hepatic encephalopathy patients (48.5 ± 13.3 vs. 45.6 ± 15.6 μmol/L, p = 0.555).<br /><strong>Discussion:</strong> The prevalence of minimal hepatic encephalopathy reported is in accordance with the international published data.<br /><strong>Conclusion:</strong> Minimal hepatic encephalopathy is a frequent condition that is present early in the course of cirrhosis, even in compensated cirrhotic patients. Therefore, this hidden entity should be actively pursued and managed properly.</p>

scholarly journals Factors associated with non-response to lactulose therapy in cirrhotic patients with minimal hepatic encephalopathy

2018 ◽  
Vol 12 (1) ◽  
pp. 15-21
Author(s):  
Shireen Ahmed ◽  
Md Golam Azam ◽  
Indrajit Kumar Datta ◽  
Md Nazmul Hoque ◽  
Tareq M Bhuiyan
Keyword(s):  
Hepatic Encephalopathy ◽  
Arterial Pressure ◽  
Minimal Hepatic Encephalopathy ◽  
Ammonia Level ◽  
Response To Treatment ◽  
Psychometric Tests ◽  
Cirrhotic Patients ◽  
Serum Ammonia Level ◽  
The Mean ◽  
Serum Ammonia

Background and objectives: Minimal hepatic encephalopathy (MHE) impairs health related quality of life and predicts overt hepatic encephalopathy (HE) in cirrhotic patients. Lactulose is effective in the treatment of MHE. But the response to lactulose treatment depends on several factors. This study was aimed to find out the contributing factors to non-response to lactulose therapy.Materials and methods: The study was carried out at the BIRDEM general hospital from September, 2013 to March, 2015. Sixty patients were enrolled to assess the response of lactulose therapy in cirrhotic patients with MHE. MHE was diagnosed based on abnormal psychometric tests namely, number connection test (NCT), digit symbol test (DST) and high serum ammonia level. A daily dose of 30-60 ml of lactulose was given to all patients for one month. The response to treatment with regard to MHE was determined after one month using defined criteria. The response was graded as responder and non-responder.Results: The mean age of the study population was 57.0±10.3 years. Out of 60 cases, 46 (77%) were male and 39 (65%) had diabetes. Out of 60 enrolled MHE cases, 16 (27%) had Child-Turcotte-Pugh-A (CTP-A) score and 44 (73%) belonged to CTP-B & C category. Out of 60 MHE cases, 23 (38.3%) showed improvement in their MHE status based on normalization of psychometric tests and reduction of serum ammonia level to ≤32 μmol/L. Age, gender and diabetes were not associated with the response to lactulose therapy. Low baseline arterial pressure was significantly (p=0.003) associated with non-response to lactulose treatment. The mean baseline ammonia level was higher significantly among the nonresponders compared to the responders (83.6±21.4 μmol/L vs 58.8±19.8 μmol/L, p<0.001). Compared to responders, low serum sodium and potassium and raised serum bilirubin levels of non-responders at baseline were found significantly (p<0.05) associated with non-response to one month of lactulose treatment. Initial hemoglobulin, peripheral leucocyte and platelet counts did not have any effect on the response to lactulose treatment in MHE cases.Conclusions: The status of MHE in patients with cirrhosis improved by one-month treatment with lactulose. Baseline low arterial pressure, hyperammonemia, hypokalemia and hyponatremia were major contributors to non-response to lactulose therapy. The findings of the study would be useful in treating patients of cirrhosis with MHE.IMC J Med Sci 2018; 12(1): 15-21

scholarly journals Patients with Minimal Hepatic Encephalopathy Show Altered Thermal Sensitivity and Autonomic Function

2021 ◽  
Vol 10 (2) ◽  
pp. 239
Author(s):  
Dalia Rega ◽  
Mika Aiko ◽  
Nicolás Peñaranda ◽  
Amparo Urios ◽  
Juan-José Gallego ◽  
...  
Keyword(s):  
Nervous System ◽  
Hepatic Encephalopathy ◽  
Quantitative Sensory Testing ◽  
Autonomic Function ◽  
Thermal Sensitivity ◽  
Somatosensory System ◽  
Minimal Hepatic Encephalopathy ◽  
Heat Pain ◽  
Sensory Testing ◽  
Cirrhotic Patients

Cirrhotic patients may experience alterations in the peripheral nervous system and in somatosensory perception. Impairment of the somatosensory system could contribute to cognitive and motor alterations characteristic of minimal hepatic encephalopathy (MHE), which affects up to 40% of cirrhotic patients. We assessed the relationship between MHE and alterations in thermal, vibration, and/or heat pain sensitivity in 58 cirrhotic patients (38 without and 20 with MHE according to Psychometric Hepatic Encephalopathy Score) and 39 controls. All participants underwent attention and coordination tests, a nerve conduction study, autonomic function testing, and evaluation of sensory thresholds (vibration, cooling, and heat pain detection) by electromyography and quantitative sensory testing. The detection thresholds for cold and heat pain on the foot were higher in patients with, than those without MHE. This hyposensitivity was correlated with attention deficits. Reaction times in the foot were longer in patients with, than without MHE. Patients with normal sural nerve amplitude showed altered thermal sensitivity and autonomic function, with stronger alterations in patients with, than in those without MHE. MHE patients show a general decrease in cognitive and sensory abilities. Small fibers of the autonomic nervous system and thermal sensitivity are altered early on in MHE, before large sensory fibers. Quantitative sensory testing could be used as a marker of MHE.

scholarly journals Activation of soluble guanylate cyclase by nitric oxide in lymphocytes correlates with minimal hepatic encephalopathy in cirrhotic patients

2007 ◽  
Vol 7 (Suppl 1) ◽  
pp. P18
Author(s):  
Vicente Felipo ◽  
Blanca Piedrafita ◽  
Amparo Urios ◽  
Miguel A Serra ◽  
A del Olmo ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Hepatic Encephalopathy ◽  
Guanylate Cyclase ◽  
Soluble Guanylate Cyclase ◽  
Minimal Hepatic Encephalopathy ◽  
Cirrhotic Patients

scholarly journals Reduced Cortical Complexity in Cirrhotic Patients with Minimal Hepatic Encephalopathy

2020 ◽  
Vol 2020 ◽  
pp. 1-7 ◽  
Author(s):  
Qiu-Feng Chen ◽  
Xiao-Hong Zhang ◽  
Tian-Xiu Zou ◽  
Nao-Xin Huang ◽  
Hua-Jun Chen
Keyword(s):  
Hepatic Encephalopathy ◽  
Cognitive Performance ◽  
Gray Matter Volume ◽  
Structural Complexity ◽  
Cingulate Cortex ◽  
Minimal Hepatic Encephalopathy ◽  
Anterior Cingulate ◽  
Psychiatric Disease ◽  
Cirrhotic Patients ◽  
The Right

Purpose. Gray matter volume loss, regional cortical thinning, and local gyrification index alteration have been documented in minimal hepatic encephalopathy (MHE). Fractal dimension (FD), another morphological parameter, has been widely used to describe structural complexity alterations in neurological or psychiatric disease. Here, we conducted the first study to investigate FD alterations in MHE. Methods and Materials. We performed high-resolution structural magnetic resonance imaging on cirrhotic patients with MHE (n=20) and healthy controls (n=21). We evaluated their cognitive performance using the psychometric hepatic encephalopathy score (PHES). The regional FD value was calculated by Computational Anatomy Toolbox (CAT12) and compared between groups. We further estimated the association between patients’ cognitive performance and FD values. Results. MHE patients presented significantly decreased FD values in the left precuneus, left supramarginal gyrus, right caudal anterior cingulate cortex, right isthmus cingulate cortex, right insula, bilateral pericalcarine cortex, and bilateral paracentral cortex compared to normal controls. In addition, the FD values in the right isthmus cingulate cortex and right insula were shown to be positively correlated with patients’ cognitive performance. Conclusion. Aberrant cortical complexity is an additional characteristic of MHE, and FD analysis may provide novel insight into the neurobiological basis of cognitive dysfunction in MHE.

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