Inhibitory Control Test for the Diagnosis of Minimal Hepatic Encephalopathy

被引:179
作者
Bajaj, Jasmohan S. [1 ]
Hafeezullah, Muhammad [2 ]
Franco, Jose [2 ]
Varma, Rajiv R. [2 ]
Hoffmann, Raymond G. [3 ]
Knox, Joshua F. [2 ]
Hischke, Darrell [2 ]
Hammeke, Thomas A. [4 ]
Pinkerton, Steven D. [5 ]
Saeian, Kia [4 ]
机构
[1] Virginia Commonwealth Univ, Div Gastroenterol Hepatol & Nutr, Richmond, VA 23284 USA
[2] Med Coll Wisconsin, Div Gastroenterol & Hepatol, Milwaukee, WI 53226 USA
[3] Med Coll Wisconsin, Dept Populat Hlth, Div Biostat, Milwaukee, WI 53226 USA
[4] Med Coll Wisconsin, Div Neuropsychol, Milwaukee, WI 53226 USA
[5] Med Coll Wisconsin, Dept Psychiat & Behav Med, Milwaukee, WI 53226 USA
关键词
D O I
10.1053/j.gastro.2008.07.021
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background & Aims: Minimal hepatic encephalopathy (MHE) is difficult to diagnose. The Inhibitory Control Test (ICT) measures response inhibition and has diagnosed MHE with 90% sensitivity and specificity in a selected population; high lure and low target rates indicated poor ICT performance. We studied the reliability and validity of ICT for MHE diagnosis. Methods: ICT was compared with a psychometric battery (standard psychometric tests [SPT]) for MHE diagnosis and overt hepatic encephalopathy (OHE) prediction. ICT was administered twice for test-retest reliability, before/after transvenous intrahepatic portosystemic shunting (TIPS), and before/after yogurt treatment. The time taken by 2 medical assistants (MA) to administer ICT was recorded and compared with that of a psychologist for cost analysis. Results: One hundred thirty-six cirrhotic patients and 116 age/education-matched controls were studied. ICT (>5 lures) had 88% sensitivity for MHE diagnosis with 0.902 area under the curve for receiver operating characteristic. MHE-positive patients had significantly higher ICT lures (11 vs 4, respectively, P = .0001) and lower targets (92% vs 97%, respectively, P = .0001) compared with MHE-negative patients. The test/retest reliability for ICT lures (n = 50, r = 0.90, P = .0001) was high. ICT and SPT were equivalent in predicting OHE (21%). ICT lures significantly worsened after TIPS (n = 10; 5 vs 9, respectively; P = .02) and improved after yogurt supplementation (n = 18, 10 vs S, respectively; P = .002). The MAs were successfully trained to administer ICT; the time required for test administration and the associated costs were smaller for ICT than for SPT. Conclusions: ICT is a sensitive, reliable, and valid test for MHE diagnosis that can be administered inexpensively by MAs.
引用
收藏
页码:1591 / 1600
页数:10
相关论文
共 37 条
[1]  
American Medical Association (AMA), 2007, CURR PROC TERM
[2]   Probiotic yogurt for the treatment of minimal hepatic encephalopathy [J].
Bajaj, Jasmohan S. ;
Saeian, Kia ;
Christensen, Kenneth M. ;
Hafeezullah, Muhammad ;
Varma, Rajiv R. ;
Franco, Jose ;
Pleuss, Joan A. ;
Krakower, Glenn ;
Hoffmann, Raymond G. ;
Binion, David G. .
AMERICAN JOURNAL OF GASTROENTEROLOGY, 2008, 103 (07) :1707-1715
[3]   Navigation skill impairment: Another dimension of the driving difficulties in minimal hepatic encephalopathy [J].
Bajaj, Jasmohan S. ;
Hafeezullah, Muhammad ;
Hoffmann, Raymond G. ;
Varma, Rajiv R. ;
Franco, Jose ;
Binion, David G. ;
Hammeke, Thomas A. ;
Saeian, Kia .
HEPATOLOGY, 2008, 47 (02) :596-604
[4]   Minimal hepatic encephalopathy: A vehicle for accidents and traffic violations [J].
Bajaj, Jasmohan S. ;
Hafeezullah, Muhammad ;
Hoffmann, Raymond G. ;
Saeian, Kia .
AMERICAN JOURNAL OF GASTROENTEROLOGY, 2007, 102 (09) :1903-1909
[5]   Inhibitory control test is a simple method to diagnose minimal hepatic encephalopathy and predict development of overt hepatic encephalopathy [J].
Bajaj, Jasmohan S. ;
Saeian, Kia ;
Verber, Matthew D. ;
Hischke, Darrell ;
Hoffmann, Raymond G. ;
Franco, Jose ;
Varma, Rajiv R. ;
Rao, Stephen M. .
AMERICAN JOURNAL OF GASTROENTEROLOGY, 2007, 102 (04) :754-760
[6]   Testing for minimal hepatic encephalopathy in the United States: An AASLD survey [J].
Bajaj, Jasmohan Singh ;
Etemadian, Ashkan ;
Hafeezullah, Muhammad ;
Saeian, Kia .
HEPATOLOGY, 2007, 45 (03) :833-834
[7]   Assessing attention: Comparison of response-inhibition and traditional continuous performance tests [J].
Ballard, JC .
JOURNAL OF CLINICAL AND EXPERIMENTAL NEUROPSYCHOLOGY, 2001, 23 (03) :331-350
[8]   Prevalence and natural history of subclinical hepatic encephalopathy in cirrhosis [J].
Das, A ;
Dhiman, RK ;
Saraswat, VA ;
Verma, M ;
Naik, SR .
JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 2001, 16 (05) :531-535
[9]   Neuropsychological assessment of response inhibition in adults with ADHD [J].
Epstein, JN ;
Johnson, DE ;
Varia, IM ;
Conners, CK .
JOURNAL OF CLINICAL AND EXPERIMENTAL NEUROPSYCHOLOGY, 2001, 23 (03) :362-371
[10]   Hepatic encephalopathy-definition, nomenclature, diagnosis, and quantification: Final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998 [J].
Ferenci, P ;
Lockwood, A ;
Mullen, K ;
Tarter, R ;
Weissenborn, K ;
Blei, AT .
HEPATOLOGY, 2002, 35 (03) :716-721