Covert hepatic encephalopathy: does the mini-mental state examination help?

Area of Science:

• Hepatology
• Neurology
• Psychometry

Background:

• The Mini-Mental State Examination (MMSE) is used for hepatic encephalopathy (HE) diagnosis.
• Its abnormal threshold and diagnostic validity in cirrhosis patients are not well-established.
• This study aimed to evaluate MMSE performance in cirrhosis patients without overt HE.

Purpose of the Study:

• To assess the diagnostic and prognostic validity of the MMSE in cirrhosis patients.
• To determine an appropriate MMSE threshold for identifying HE risk.
• To evaluate MMSE's ability to predict HE-related hospitalizations.

Main Methods:

• 191 cirrhosis outpatients without overt HE underwent clinical assessment, MMSE, EEG, and PHES.
• 117 patients were followed for 8 ± 5 months for HE-related hospitalizations.
• MMSE thresholds of 26 and 27 were tested against clinical, EEG, and PHES abnormalities.

Main Results:

• An MMSE score below 26 predicted HE-related hospitalizations (Cox-Mantel: P = 0.001).
• Patients with MMSE < 26 were older but had similar liver dysfunction and ammonia levels.
• Abnormal EEG, PHES, and HE history correlated with lower MMSE scores (P < 0.01).
• Spatial orientation and writing items on the MMSE showed significant correlation with HE indices.

Conclusions:

• An MMSE score < 26 identifies older cirrhosis patients prone to HE.
• This threshold aids in identifying individuals at increased risk for HE manifestation.
• MMSE, particularly spatial orientation and writing, can be a valuable tool in HE assessment.