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Neuropsychological characterization and detection of subclinical hepatic encephalopathy
M McCrea1, J Cordoba, G Vessey
1Department of Psychiatry, Northwestern University Medical School, Chicago, Ill., USA.
Objective:
To elucidate the nature of the neuropsychological deficits associated with subclinical hepatic encephalopathy.
Design:
Prospective study comparing the performance of patients with liver disease and carefully matched normal controls on a short but comprehensive neuropsychological test battery.
Setting:
A university medical center.
Participants:
Twenty patients with cirrhosis (10 alcoholic and 10 nonalcoholic) and 20 controls carefully matched on the basis of age, sex, education, and alcohol history.
Results:
The cirrhotic patients exhibited relatively selective deficits in complex attentional and fine motor skills, with preservation of general intellectual ability, memory, language and visuospatial perception.
Conclusions:
This pattern of neuropsychological deficits suggests a subcortical pathophysiology, possibly reflecting involvement of the basal ganglia. These neuropsychological findings are consistent with recent neuroradiological, electrophysiological, and neurophysiological research implicating basal ganglia involvement in cirrhosis.