Diagnosis of subclinical hepatic encephalopathy in patients with liver cirrhosis

ABSTRACT

In addition to clinically manifest hepatic encephalopathy, a subclinical stage has been described, This stage can be detected only by psychometric and/or neurophysiological tests. Early diagnosis and treatment of subclinical hepatic encephalopathy [SHE] may improve the daily functioning of the patients. We used two psychometric tests [Number Connection Test and Digit Symbol Test] and electroencephalography [EEG] to detect the prevalence of SHE in 200 patients with stable liver cirrhosis. One hundred age-matched healthy controls underwent the psychometric tests, while only 40 of them shared in the biochemical evaluation of the liver disease. Seventy-sex [38%] of the 200 patients, had SHE. SHE was diagnosed by the presence of at least one abnormal psychometric test and/or abnormal slowing of the EEG. Sixty-six [33%] of the 200 patients, had abnormal results on at least one psychometric test. Old age or low education may cause false positive psychometric tests. Sixty [30%] of the 200 patients, had slowing of their EEGs. A positive correlation was found between the severity of EEG slowing and the severity of liver disease and also the disease duration. It was noticed that some patients had only abnormal one psychometric test or only EEG slowing. This poor overlap between the different tools used for the diagnosis of SHE suggests that the use of a multiple psychometric test battery conjoined with neurophysiologic tests may lead to better and earlier diagnosis of SHE which appears to be prevalent among patients with stable cirrhosis