Abstract
Minimal hepatic encephalopathy (HE) is characterized by a decrease of psychomotor speed, and deficits in visual perception, visuo-spatial orientation, and visuo-constructive abilities. Attention deficits have also been proposed to be part of the syndrome. Several attempts were made in the past to elaborate suitable psychometric means for the assessment of minimal HE. However, there is still no “gold standard” for the diagnosis of minimal HE. We recently evaluated the so called “PSE-Test” for the assessment of minimal HE, a test battery which does not include a test predominantly aimed at the assessment of attention. We therefore presented a battery of attention tests in addition to the PSE-Test to a group of cirrhotics without clinical signs of HE compared to a healthy control group matched for age and education to determine whether the addition of special attention tests would increase the diagnostic sensitivity of the PSE-Test. It was shown that the patients with a pathological PSE-Test result differed significantly from controls in all attention tests applied, while the patients with normal PSE-Test results achieved attention test results similar to that of the controls. Thus, the PSE-Test results represent attention deficits as well as deficits in motor skills, visuo-spatial orientation, and visual construction.
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REFERENCES
Brickenkamp, R. (1981). Test d2. Aufmerksamkeits-Belastungs-Test, Verlag für Psychologie J. Hogrefe, Göttingen-Toronto-Zürich.
Carter, C.S., Mintun, M., Nichols, T., and Cohen, J.D. (1997). Anterior cingulate gyrus dysfunction and selective attention deficits in schizophrenia: (15O)H2O PET study during single-trial stroop task performance. Am. J. Psychiatry 154:1670–1675.
Elsass, P., Lund, Y., and Ranek, L. (1978). Encephalopathy in patients with cirrhosis of the liver. A neuropsychological study. Scand. J. Gastroenterol. 13:241–247.
Gilberstadt, S.J., Gilberstadt, H., Zieve, L., Buegel, B., Collier, R.O., and McClain, C.J. (1980). Psychomotor performance defects in cirrhotic patients without overt encephalopathy. Arch. Intern. Med. 140:519–521.
Gitlin, N., Lewis, D.C., and Hinkley, L. (1986). The diagnosis and prevalence of subclinical hepatic encephalopathy in apparently healthy, ambulant, non-shunted patients with cirrhosis. J. Hepatol. 3:75–82.
Hamster, W. (1982). Neuropsychologie der latenten portosystemischen Enzephalopathie, Habilitationsschrift, Medizinische Fakultät der Eberhard-Karls-Universität Töbingen.
Hegedus, A., Tarter, R.E., Van Thiel, D.H., Schade, R.R., Gavaler, J.S., and Starzl, T.E. (1984). Neuropsychiatric characteristics associated with primary biliary cirrhosis. Int. J. Psychiat. Med. 14:303–314.
Klingberg, T., O'sullivan, B.T., and Roland, P.E. (1997). Bilateral activation of fronto-parietal networks by incrementing demand in a working memory task. Cereb. Cortex 7:465–471.
Koch, H., Schauder, P., Schäfer, G., Dahme, B., Ebel, W., Vahldiek, B., and König, F. (1990). Untersuchungen zur Diagnose und Prävalenz der latenten hepatischen Encephalopathie. Z. Gastroenterol. 28:610–615.
Lockwood, A.H. (2000) “What's in a name?” Improving the care of cirrhotics. J. Hepatol. 32:859–861.
Lockwood, A.H., Murphy, B.W., Donnelly, K.Z., Mahl, T.C., and Perini, S. (1993). Positron-emission tomographic localization of abnormalities of brain metabolism in patients with minimal hepatic encephalopathy. Hepatology 18:1061–1068.
Lockwood, A.H., Weissenborn, K., Burchert, W., Bokemeyer, M., and Wack, D.S. (1998). Neuropsychological test deficits correlate with altered cerebral glucose metabolism in patients with non-alcoholic cirrhosis. Neurology 50:A253.
Loguercio, C., Del Vecchio-Blanco, C., and Coltorti, M. (1984). Psychometric tests and “latent” portal-systemic encephalopathy. Brit. J. Clin. Pract. 38:407–411.
Lynch, J.C., Montcastle, V.B., Talbot, W.H., and Yin, T.C.T. (1977). Parietal lobe mechanisms for directed visual attention. J. Neurophysiol. 40:362–389.
McCarthy, G., Puce, A., Constable, R.T., Krystal, J.H., Gore, J.C., and Goldman-Rakic, P. (1996). Activation of human prefrontal cortex during spatial and nonspatial working memory tasks measured by functional MRI. Cereb. Cortex 6:600–611.
McCrea, M., Cordoba, J., Vessey, G., Blei, A.T., and Randolph, Ch. (1996). Neuropsychological characterization and detection of subclinical hepatic encephalopathy. Arch. Neurol. 53:758–763.
Mesulam, M.M. (1981). A cortical network for directed attention and unilateral neglect. Ann. Neurol. 10:309–325.
Mirsky, A.F. (1989). The neuropsychology of attention: Elements of a complex behavior. In (E. Perecman, ed.) Integrating Theory and Practice in Clinical Neuropsychology, Hillsdale NJ, Erlbaum.
Nobre, A.C., Sebestyen, G.N., Gitelman, D.R., Mesulam, M.M., Frackowiak, R.S.J., and Frith, C.D. (1997). Functional localization of the system for visuospatial attention using positron emission tomography. Brain 120:515–533.
Pardo, J.V., Fox, P.T., and Raichle, M.E. (1991). Localization of a human system for sustained attention by positron emission tomography. Nature 349:61–64.
Posner, M.I., Walker, F.J.F., and Rafal, R.D. (1984). Effects of parietal injury on covert orienting of attention. J. Neurosci. 4:1863–1874.
Quero, J.C., Hartmann, I.J.C., Meulstee, J., Hop, W.C.J., and Schalm, S.W. (1996). The diagnosis of subclinical hepatic encephalopathy in patients with cirrhosis using neuropsychological tests and automated electroencephalogram analysis. Hepatology 24:556–560.
Rehnström, S., Simert, G., Hansson, J.A., Johnson, G., and Vang, J. (1977). Chronic hepatic encephalopathy. A psychometrical study. Scand. J. Gastroenterol. 12:305–311.
Rikkers, L., Jenko, P., Rudman, D., and Freides, D. (1978). Subclinical hepatic encephalopathy: Detection, prevalence, and relationship to nitrogen metabolism. Gastroenterology 75:462–469.
Schomerus, H., and Hamster, W. (1998). Neuropsychological aspects of portal-systemic encephalopathy. Metab. Brain Dis. 13:361–377.
Schomerus, H., Hamster, W., Blunck, H., Reinhard, K., Mayer, K., and Dölle, W. (1981). Latent portasystemic encephalopathy: I. Nature of cerebral functional defects and their effect on fitness to drive. Dig. Dis. Sci. 26:622–630.
Schomerus, H., Weissenborn, K., Hamster, W., Rückert, N., and Hecker, H. (1999). PSE-Syndrom-Test, Swets Test Services, Swets & Zeitlinger B.V., Frankfurt.
Sood, G.K., Sarin, S.K., Mahaptra, J., and Broor, S.L. (1989). Comparative efficacy of psychometric tests in detection of subclinical hepatic encephalopathy in nonalcoholic cirrhotics: Search for a rational approach. Am. J. Gastroenterol. 84:156–159.
Tarter, R.E., Hegedus, A.M., Van Thiel, D.H., Edwards, N., and Schade, R.R. (1987). Neurobehavioral correlates of cholestatic and hepatocellular disease: Differentiation according to disease specific characteristics and severity of the identified cerebral dysfunction. Intern. J. Neurosci. 32:901–910.
Tewes, U. (1991). HAWIE-R. Hamburg-Wechsler-Intelligenztest für Erwachsene. Revision 1991, Verlag Hans Huber, Bern-Stuttgart-Toronto.
Weissenborn, K., Burchert, W., Bokemeyer, M., Ehrenheim, C., Kolbe, H., Manns, M.P., and Dengler, R. (1997a). Regional differences of cerebral glucose metabolism in patients with liver cirrhosis depending on the grade of porto-systemic encephalopathy (PSE). In (C. Record and H. Al Mardini, eds.) Advances in Hepatic Encephalopathy and Metabolism in Liver Disease, Medical Faculty, University of Newcastle upon Tyne, Newcastle upon Tyne, pp. 359–363.
Weissenborn, K., Ennen, J., Rückert, N., Schomerus, H., Dengler, R., Manns, M.P., and Hecker, H. (1997b). The PSE-Test: An attempt to standardise neuropsychological assessment of latent portosystemic encephalopathy (PSE). In (C. Record and H. Al Mardini, eds.) Advances in Hepatic Encephalopathy and Metabolism in Liver Disease, Medical Faculty, University of Newcastle upon Tyne, Newcastle upon Tyne, pp. 489–494.
Zeegen, R., Drinkwater, J.E., and Dawson, A.M. (1970). Method for measuring cerebral dysfunction in patients with liver disease. Brit. Med. J. 2:633–636.
Zimmermann, P., and Fimm, B. (1993). Testbatterie zur Aufmerksamkeitsprüfung (TAP), Version 1.02, Psytest, Freiburg.
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Weissenborn, K., Heidenreich, S., Ennen, J. et al. Attention Deficits in Minimal Hepatic Encephalopathy. Metab Brain Dis 16, 13–19 (2001). https://doi.org/10.1023/A:1011654210096
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DOI: https://doi.org/10.1023/A:1011654210096