RESUMO
Minimal hepatic encephalopathy [MHE] impairs health-related quality of life and driving ability of the patient. We assessed the utility of the inhibitory control test [ICT], critical flicker frequency [CFF], and psychometry in the diagnosis of MHE. Consecutive patients with cirrhosis underwent number connection tests A and B [NCT-A, B], digit symbol test [DST], line tracing test [LTT], serial dot test [SDT], CFF, and ICT at baseline and after four hours. Fifty healthy subjects served as controls for the ICT test. Fifty patients with cirrhosis [43.4 +/- 10.2 yrs, M: F 42:8] underwent psychometric tests [NCT-A [48.3 +/- 17.7 vs. 42.6 +/- 17.3 sec, P = 0.001], NCT-B [85.7 +/- 40.1 vs. 90.2 +/- 37.0 sec, P = 0.18], DST [23.5 +/- 9.3 vs. 23.0 +/- 8.7, P = 0.45], LTT [96.6 +/- 48.2 vs. 96.8 +/- 46.8 sec, P = 0.92], SDT [88.0 +/- 39.5 vs. 83.4 +/- 37.2 sec, P = 0.02]] at baseline and after four hours. Target accuracy of ICT was lower in patients with cirrhosis compared with controls [88.4 +/- 5.6 vs. 95.6 +/- 2.1, P = 0.01], whereas ICT lures were higher [18.3 +/- 4.2 vs. 10.2 +/- 2.8, P = 0.01]. Patients with cirrhosis showed a reduction in lures in the second evaluation compared with the first [18.3 +/- 4.2 vs. 17.1 +/- 4.3, P = 0.003] but no change in target accuracy [88.4 +/- 5.6 vs. 88.4 +/- 5.3, P = 0.97]. Control subjects did not show any change either in lures [10.2 +/- 2.8 vs. 10.3 +/- 2.1, P = 0.65] or target accuracy [95.6 +/- 2.1 vs. 95.5 +/- 2.2, P = 0.82]. The sensitivity and specificity of ICT test for the diagnosis of MHE at lure rate >16.5 was 88.5 and 56%, respectively. CFF in patients with MHE [38.4 +/- 1.8 vs. 38.6 +/- 1.5, P = 0.3] and non MHE [40.6 +/- 2.2 vs. 40.8 +/- 2.2, P = 0.6] did not show any difference after four hours as in controls [41.9 +/- 2.4 vs. 42.1 +/- 2.0, P = 0.3]. Thirty one [31%] patients preferred psychometric tests, 57 [57%] preferred CFF and only 12 [12%] preferred ICT [P = 0.001]. ICT, CFF, and psychometric tests are useful tools to assess MHE, and CFF was preferred by this study cohort