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Inhibitory control test for the diagnosis of minimal hepatic encephalopathy
Jasmohan S Bajaj1, Muhammad Hafeezullah, Jose Franco
1Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA. jasmohan.bajaj@va.gov
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 5, 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.
Insights
The Inhibitory Control Test (ICT) reliably diagnoses minimal hepatic encephalopathy (MHE). This sensitive and valid test is cost-effective for MHE diagnosis and can be administered by medical assistants.
Area of Science:
- Neuroscience
- Gastroenterology
- Psychometrics
Background:
- Minimal hepatic encephalopathy (MHE) presents diagnostic challenges.
- The Inhibitory Control Test (ICT) assesses response inhibition.
- Previous studies indicated ICT's potential for MHE diagnosis in specific populations.
Purpose of the Study:
- To evaluate the reliability and validity of the ICT for diagnosing MHE.
- To compare ICT performance against a standard psychometric battery (SPT).
- To assess ICT's utility in predicting overt hepatic encephalopathy (OHE) and its response to interventions.
Main Methods:
- ICT was administered to cirrhotic patients and controls, with test-retest reliability assessed.
- ICT was compared with SPT for MHE diagnosis and OHE prediction.
- ICT performance was evaluated before and after transjugular intrahepatic portosystemic shunting (TIPS) and yogurt supplementation.
- Time and cost of ICT administration by medical assistants (MAs) were analyzed.
Main Results:
- ICT demonstrated 88% sensitivity for MHE diagnosis, with high test-retest reliability (r=0.90).
- MHE-positive patients showed significantly poorer ICT performance (more lures, fewer targets) compared to MHE-negative patients.
- ICT and SPT showed equivalent OHE prediction rates (21%); ICT performance varied with interventions (worsened post-TIPS, improved post-yogurt).
- Medical assistants could administer ICT efficiently and cost-effectively compared to SPT.
Conclusions:
- The ICT is a sensitive, reliable, and valid tool for diagnosing minimal hepatic encephalopathy.
- ICT offers a cost-effective and practical diagnostic solution for MHE.
- Medical assistants can be trained to administer the ICT, enhancing its clinical applicability.
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