Minimal Hepatic Encephalopathy in Cirrhotic Patients: A New Simple and Fast Digital Screening Method

Area of Science:

• Hepatology
• Neuroscience
• Digital Health

Background:

• Minimal hepatic encephalopathy (MHE) is a severe cirrhosis complication impacting quality of life.
• Current diagnostic methods for MHE are time-consuming and difficult to implement in routine clinical practice.

Purpose of the Study:

• To develop a simple, smartphone-based self-assessment tool for MHE screening.
• To evaluate the efficacy of digital tests in detecting MHE.

Main Methods:

• 92 cirrhosis patients and 20 controls performed smartphone-based Tip test (TT), number connection test (dNCT), and modified Stroop test (ST).
• Digital test results were correlated with the Psychometric Hepatic Encephalopathy Score (PHES).
• Impact of age, gender, education, and MELD scores on test performance was analyzed.

Main Results:

• All digital tests correlated well with PHES (TT r=-0.76, dNCT r=-0.58, ST r=-0.65; p<0.001).
• Digital tests were significantly faster than PHES (e.g., TT median 41s vs. PHES median 322s).
• The Tip test demonstrated the highest diagnostic accuracy (AUC=0.835) and was unaffected by language or color blindness.

Conclusions:

• Smartphone-based digital tests are suitable for MHE screening.
• The Tip test is a fast, accurate, and accessible method for MHE detection in cirrhotic patients.
• App-based alerts with adjusted thresholds can aid in monitoring cognitive changes in cirrhosis.