Jeong Jae Yoon, Jun Dae Won, Bai Daiseg, Kim Ji Yean, Sohn Joo Hyun, Ahn Sang Bong, Kim Sang Gyune, Kim Tae Yeob, Kim Hyoung Su, Jeong Soung Won, Cho Yong Kyun, Song Do Seon, Kim Hee Yeon, Jung Young Kul, Yoon Eileen L
Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
Division of Clinical Psychology, Department of Psychiatry, Yeungnam University Hospital, Daegu, Korea.
J Korean Med Sci. 2017 Sep;32(9):1484-1490. doi: 10.3346/jkms.2017.32.9.1484.
The aim of this study was to validate a new paper and pencil test battery to diagnose minimal hepatic encephalopathy (MHE) in Korea. A new paper and pencil test battery was composed of number connection test-A (NCT-A), number connection test-B (NCT-B), digit span test (DST), and symbol digit modality test (SDMT). The norm of the new test was based on 315 healthy individuals between the ages of 20 and 70 years old. Another 63 healthy subjects (n = 31) and cirrhosis patients (n = 32) were included as a validation cohort. All participants completed the new paper and pencil test, a critical flicker frequency (CFF) test and computerized cognitive function test (visual continuous performance test [CPT]). The scores on the NCT-A and NCT-B increased but those of DST and SDMT decreased according to age. Twelve of the cirrhotic patients (37.5%) were diagnosed with MHE based on the new paper and pencil test battery. The total score of the paper and pencil test battery showed good positive correlation with the CFF (r = 0.551, P < 0.001) and computerized cognitive function test. Also, this score was lower in patients with MHE compared to those without MHE (P < 0.001). Scores on the CFF (32.0 vs. 28.7 Hz, P = 0.028) and the computer base cognitive test decreased significantly in patients with MHE compared to those without MHE. Test-retest reliability was comparable. In conclusion, the new paper and pencil test battery including NCT-A, NCT-B, DST, and SDMT showed good correlation with neuropsychological tests. This new paper and pencil test battery could help to discriminate patients with impaired cognitive function in cirrhosis (registered at Clinical Research Information Service [CRIS], https://cris.nih.go.kr/cris, KCT0000955).
本研究的目的是验证一种新的纸笔测试组合，用于诊断韩国的轻微肝性脑病（MHE）。一种新的纸笔测试组合由数字连接测试A（NCT-A）、数字连接测试B（NCT-B）、数字广度测试（DST）和符号数字模态测试（SDMT）组成。新测试的常模基于315名年龄在20至70岁之间的健康个体。另外63名健康受试者（n = 31）和肝硬化患者（n = 32）被纳入作为验证队列。所有参与者均完成了新的纸笔测试、临界闪烁频率（CFF）测试和计算机化认知功能测试（视觉持续操作测试[CPT]）。根据年龄，NCT-A和NCT-B的分数升高，而DST和SDMT的分数降低。基于新的纸笔测试组合，12名肝硬化患者（37.5%）被诊断为MHE。纸笔测试组合的总分与CFF（r = 0.551，P < 0.001）和计算机化认知功能测试呈良好的正相关。此外，与无MHE的患者相比，MHE患者的该分数更低（P < 0.001）。与无MHE的患者相比，MHE患者的CFF分数（32.0对28.7 Hz，P = 0.028）和计算机基础认知测试分数显著降低。重测信度相当。总之，包括NCT-A、NCT-B、DST和SDMT的新纸笔测试组合与神经心理学测试显示出良好的相关性。这种新的纸笔测试组合有助于鉴别肝硬化中认知功能受损的患者（已在临床研究信息服务[CRIS]注册，https://cris.nih.go.kr/cris，KCT0000955）。
