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Psychometric methods for diagnosing and monitoring minimal hepatic encephalopathy —current validation level and practical use

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Abstract

Hepatic encephalopathy (HE) is cerebral dysfunction caused by liver failure and inflicts 30-40% of patients with liver cirrhosis during their disease course. Clinically manifest HE is often preceded by minimal HE (MHE) — a clinically undetectable cognitive disturbance closely associated with loss of quality of life. Accordingly, detecting and treating MHE improve the patients’ daily functioning and prevent HE-related hospital admissions. The scope of this review article is to create an overview of the validation level and usage of psychometric tests used to detect MHE: Portosystemic hepatic encephalopathy test, continuous reaction time test, Stroop EncephalApp, animal naming test, critical flicker frequency test, and inhibitory control test. Our work is aimed at the clinician or scientist who is about to decide on which psychometric test would fit best in their clinic, cohort, or study. First, we outline psychometric test validation obstacles and requirements. Then, we systematically approach the literature on each test and select well-conducted studies to answer the following questions:

• Which percentage of patients with cirrhosis does the test deem as having MHE?

• Is the test able to predict clinically manifest HE?

• Is there a well-known test-retest variation and inter-observer variation?

• Is the test able to detect a treatment response?

• Is the test result affected by age, educational level, gender, or comorbidities?

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  1. Department of Gastroenterology and Hepatology, University Hospital South Denmark, Finsensgade 35, 6700, Esbjerg, Denmark

    Mads Kingo Guldberg Hansen, Lea Ladegaard Grønkjær & Mette Munk Enok Lauridsen

  2. Department of Hepatology and Gastroenterology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark

    Kristoffer Kjærgaard, Lotte Lindgreen Eriksen, Anne Catrine Daugaard Mikkelsen, Thomas Damgaard Sandahl, Hendrik Vilstrup & Karen Louise Thomsen

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Hansen, M.K.G., Kjærgaard, K., Eriksen, L.L. et al. Psychometric methods for diagnosing and monitoring minimal hepatic encephalopathy —current validation level and practical use. Metab Brain Dis 37, 589–605 (2022). https://doi.org/10.1007/s11011-022-00913-w

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