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Using saccades to diagnose covert hepatic encephalopathy

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Abstract

Covert Hepatic Encephalopathy (CHE), previously known as Minimal Hepatic Encephalopathy, is a subtle cognitive defect found in 30–70 % of cirrhosis patients. It has been linked to poor quality of life, impaired fitness to drive, and increased mortality: treatment is possible. Despite its clinical significance, diagnosis relies on psychometric tests that have proved unsuitable for use in a clinical setting. We investigated whether measurement of saccadic latency distributions might be a viable alternative. We collected data on 35 cirrhosis patients at Addenbrooke’s Hospital, Cambridge, with no evidence of clinically overt encephalopathy, and 36 age-matched healthy controls. Performance on standard psychometric tests was evaluated to determine those patients with CHE as defined by the World Congress of Gastroenterology. We then compared visually-evoked saccades between those with CHE and those without, as well as reviewing blood test results and correlating saccadic latencies with biochemical parameters and prognostic scores. Cirrhosis patients have significantly longer median saccadic latencies than healthy controls. Those with CHE had significantly prolonged saccadic latencies when compared with those without CHE. Analysis of a cirrhosis patient’s saccades can diagnose CHE with a sensitivity of 75 % and a specificity of 75 %. We concluded that analysis of a cirrhosis patient’s saccadic latency distributions is a fast and objective measure that can be used as a diagnostic tool for CHE. This improved early diagnosis could direct avoidance of high-risk activities such as driving, and better inform treatment strategies.

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Conflict of interest

None; financial support from the University of Cambridge

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Authors and Affiliations

  1. Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK

    Nicholas Cunniffe, Henry Munby, Shona Chan, Defne Saatci, Eric Edison & R. H. S. Carpenter

  2. Department of Gastroenterology, Addenbrooke’s Hospital, Cambridge, UK

    Dunecan Massey

Authors
  1. Nicholas Cunniffe
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  2. Henry Munby
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  3. Shona Chan
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  4. Defne Saatci
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  5. Eric Edison
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  6. R. H. S. Carpenter
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  7. Dunecan Massey
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Correspondence to R. H. S. Carpenter.

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Cunniffe, N., Munby, H., Chan, S. et al. Using saccades to diagnose covert hepatic encephalopathy. Metab Brain Dis 30, 821–828 (2015). https://doi.org/10.1007/s11011-014-9647-8

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  • DOI: https://doi.org/10.1007/s11011-014-9647-8

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