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Related Concept Videos

Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test01:22

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

Michela Corrias1, Matteo Turco1, Michele D Rui1

  • 1Department of Medicine, University of Padova, Padova, Italy.

Journal of Clinical and Experimental Hepatology
|March 11, 2015
PubMed
Summary
This summary is machine-generated.

A Mini-Mental State Examination (MMSE) score below 26 identifies older patients with cirrhosis at higher risk for hepatic encephalopathy (HE). This finding aids in predicting HE-related hospitalizations in this vulnerable population.

Keywords:
EEG, electroencephalographyHE, hepatic encephalopathyMELD, model for end-stage liver diseaseMMSE, mini-mental state examinationPHES, psychometric hepatic encephalopathy scoreammoniacirrhosisdementiahepatic encephalopathyliver

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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.