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Psychometric methods for diagnosing and monitoring minimal hepatic encephalopathy -current validation level and
Mads Kingo Guldberg Hansen1, Kristoffer Kjærgaard2, Lotte Lindgreen Eriksen2
1Department of Gastroenterology and Hepatology, University Hospital South Denmark, Finsensgade 35, 6700, Esbjerg, Denmark. mads.kingo.guldberg.hansen@rsyd.dk.
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?
Insights
Minimal hepatic encephalopathy (MHE) affects up to 40% of cirrhosis patients. This review evaluates psychometric tests for MHE detection, aiding clinicians in choosing the best diagnostic tool for their patients.
Area of Science:
- Neuroscience
- Hepatology
- Psychometrics
Background:
- Hepatic encephalopathy (HE) is a significant complication of liver failure, affecting 30-40% of cirrhosis patients.
- Minimal hepatic encephalopathy (MHE) is an early, clinically undetectable cognitive impairment linked to reduced quality of life.
- Early detection and treatment of MHE are crucial for improving patient function and preventing hospital admissions.
Purpose of the Study:
- To provide an overview of the validation status and application of psychometric tests for MHE detection.
- To assist clinicians and researchers in selecting appropriate psychometric tests for MHE assessment in clinical practice or studies.
- To systematically review literature on specific MHE detection tools.
Main Methods:
- Literature review focusing on psychometric tests for MHE, including the Portosystemic hepatic encephalopathy test, continuous reaction time test, Stroop EncephalApp, animal naming test, critical flicker frequency test, and inhibitory control test.
- Systematic evaluation of well-conducted studies to assess test performance and characteristics.
- Analysis of obstacles and requirements for psychometric test validation.
Main Results:
- The review addresses key questions regarding the prevalence of MHE detected by each test, predictive ability for overt HE, test-retest and inter-observer reliability, treatment response detection, and influence of demographic factors and comorbidities.
- Detailed assessment of the validation level and usage of six specific psychometric tests.
Conclusions:
- Informed selection of psychometric tests is essential for accurate MHE diagnosis and management in cirrhosis patients.
- Understanding the strengths and limitations of each test aids in optimizing patient care and research outcomes.
- Further research may be needed to address specific validation gaps for certain psychometric tools.
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