Attention Dysfunction in Cirrhotic Patients: An Inquiry on the Role of Executive Control, Attention Orienting and Focusing
- 112 Downloads
Attention alterations are reported in cirrhotics. Aiming at clarifying attention functioning in cirrhotics, an inquiry on the functioning of the anterior (AAS) and the posterior (PAS) attention system was performed. Thirty-six cirrhotics without overt hepatic encephalopathy (24 with EEG or TMT-A alterations) and 16 matched control subjects were enrolled. The AAS was studied by the Stroop task measuring selective attention control, the PAS was studied by the Posner task and the Focus task measuring automatic covert orienting and visual focusing of attention respectively.
Cirrhotics presented a task-dependent psychomotor slowing (Stroop > Posner > Focus) with an increased percentage of errors in the incongruent condition of the Stroop task [F(1, 57) = 4.9, p < 0.03]. Class C patients had both a selective slowing [F(1, 33) = 4.3, p < 0.05] and an increased percentage of errors in the incongruent condition [F(1, 34) = 5.1, p < 0.05] compared to Class A–B patients and controls. The patients with an altered EEG performed the Stroop test significantly slowly than those without EEG alterations [F(1, 41) = 8.9, p < 0.01] and with a clear trend for a higher number of errors in the incongruent condition [F(1, 39) = 3.8, p < 0.06]. In contrast, attention orienting and focusing were maintained. In conclusion, the AAS is more sensitive than the PAS to the early stages of hepatic encephalopathy.
Key wordsAttention liver cirrhosis TMT-A EEG attention focusing attention orienting divided attention
Unable to display preview. Download preview PDF.
- Amodio, P., Del Piccolo, F., Marchetti, P., Angeli, P., Iemmolo, R., Caregaro, L., Merkel, C., Gerunda, G., and Gatta, A. (1999a). Clinical features and survivial of cirrhotic patients with subclinical cognitive alterations detected by the number connection test and computerized psychometric tests. Hepatology 29:1662–1667.CrossRefGoogle Scholar
- Amodio, P., Wenin, H., Del Piccolo, F., Mapelli, D., Montagnese, S., Pellegrini, A., Musto, C., Gatta, A., and Umilta, C. (2002). Variability of trail making test, symbol digit test and line trait test in normal people. A normative study taking into account age-dependent decline and sociobiological variables. Aging Clin. Exp. Res. 14:117–131.PubMedGoogle Scholar
- Benso, F., Turatto, M., Mascetti, G.G., and Umiltà, C. (1998). The time course of attentional focusing. Eur. J. Cogn. Psychol. 10:373–388.Google Scholar
- Ferenci, P., Lockwood, A., Mullen, K., Tarter, R., Weissenborn, K., and Blei, A.T. (2002). Hepatic encephalopathy—definition, nomenclature, diagnosis, and quantification: Final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology 35:716–721.CrossRefPubMedGoogle Scholar
- Klem, G.H., Lüders, H.O., Jasper, H.H., and Elger, C. (1999). The ten-twenty electrode system of the International Federation. In (G. Deuschal and A. Eisen, eds.), Recommandations for the Practice of Clinical Neurophysiology: Guidlines of the International Federation of Clinical Neurophysiology, Elsevier, Amsterdam, pp. 3–6.Google Scholar
- Lockwood, A.H., Weissenborn, K., Burchert, W., Bokemeyer, M., and Wack, D.S. (1998). Neuropsychological test deficit correlate with alterated cerebral glucose metabolism in patients with non-alcoholic cirrhosis. Neurology 50:A253.Google Scholar
- Shallice, T. (1988). From Neuropsychology to mental structure, Cambridge University Press, Cambridge.Google Scholar
- Weissenborn, K., Scholz, M., Hinrichs, H., Wiltfang, J., Schmidt, F.W., Kunkel, H. (1990). Neurophysiological assessment of early encephalopathy. Electroencephalogr. Clin. Neurophysiol. 75:289–295.Google Scholar