Visual attention orienting in liver cirrhosis without overt hepatic encephalopathy

The attention system in patients with liver cirrhosis has not yet been fully investigated. We therefore studied visual attention orienting in cirrhotic patients without overt hepatic encephalopathy. Seventy cirrhotic patients without overt hepatic encephalopathy (aged 57 +/- 10 yr., mean +/- s.d.) and 55 controls (aged 49 +/- 12 yr.) were enrolled. Visual attention orienting was evaluated by a computerized neuropsychological test. The Reitan A test, commonly used to detect subclinical hepatic encephalopathy, was used to evaluate mental performance. Psychometric test scores were reduced in cirrhotics compared to controls (attention test: neutral condition = 495 +/- 149 vs. 401 +/- 98 msec; valid condition = 434 +/- 110 vs. 398 +/- 84 msec; invalid condition = 485 +/- 146 vs. 392 +/- 110 msec; p < 0.001; Reitan A test = 52 +/- 20 vs. 35 +/- 11 sec., p < 0.001). The attention effect of the cue was found both in controls and cirrhotics; however, it was significantly higher in cirrhotics than in controls (61 +/- 111 vs. 33 +/- 41 msec; p < 0.002). The attention effect was directly correlated with Reitan A test (r = 0.23, p = 0.05) in cirrhotics. In conclusion, in cirrhotic patients without overt hepatic encephalopathy, visual attention orienting was present and focusing to an indexed location had a higher effect on reaction time compared to controls, possibly because of reduced basal arousal.