Department of Medicine, University of Padova, Padova, Italy.
Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy.
J Hepatol. 2019 Apr;70(4):648-657. doi: 10.1016/j.jhep.2018.12.031. Epub 2019 Jan 8.
BACKGROUND & AIMS: Hepatic encephalopathy (HE) is a syndrome of decreased vigilance and has been associated with impaired driving ability. The aim of this study was to evaluate the psychomotor vigilance task (PVT), which is used to assess both vigilance and driving ability, in a group of patients with cirrhosis and varying degrees of HE.
A total of 145 patients (120 males, 59 ± 10 years, model for end-stage liver disease [MELD] score 13 ± 5) underwent the PVT; a subgroup of 117 completed a driving questionnaire and a subgroup of 106 underwent the psychometric hepatic encephalopathy score (PHES) and an electroencephalogram (EEG), based on which, plus a clinical evaluation, they were classed as being unimpaired (n = 51), or as having minimal (n = 35), or mild overt HE (n = 20). All patients were followed up for an average of 13 ± 5 months in relation to the occurrence of accidents and/or traffic offences, HE-related hospitalisations and death. Sixty-six healthy volunteers evenly distributed by sex, age and education served as a reference cohort for the PVT.
Patients showed worse PVT performance compared with healthy volunteers, and PVT indices significantly correlated with MELD, ammonia levels, PHES and the EEG results. Significant associations were observed between neuropsychiatric performance/PVT indices and licence/driving status. PVT, PHES and EEG results all predicted HE-related hospitalisations and/or death over the follow-up period; none predicted accidents or traffic offences. However, individuals with the slowest reaction times and most lapses on the PVT were often not driving despite having a licence. When patients who had stopped driving for HE-related reasons (n = 6) were modelled as having an accident or fine over the subsequent 6 and 12 months, PVT was a predictor of accidents and traffic offences, even after correction for MELD and age.
The PVT is worthy of further study for the purposes of both HE and driving ability assessment.
Hepatic encephalopathy (HE) is a complication of advanced liver disease that can manifest as excessive sleepiness. Some patients with HE have been shown to have difficulty driving. Herein, we used a test called the Psychomotor Vigilance Task (PVT), which measures sleepiness and can also be used to assess driving competence. We showed that PVT performance is fairly stable in healthy individuals. We also showed that PVT performance parallels performance in tests which are commonly used in cirrhotic patients to measure HE. We suggest that this test is helpful in quantifying HE and identifying dangerous drivers among patients with cirrhosis.
肝性脑病（HE）是一种警觉性降低的综合征，与驾驶能力受损有关。本研究的目的是评估精神运动警觉任务（PVT），该任务用于评估警觉性和驾驶能力，在一组具有不同程度 HE 的肝硬化患者中进行。
共有 145 名患者（120 名男性，59±10 岁，终末期肝病模型 [MELD]评分 13±5）接受了 PVT；亚组 117 名患者完成了驾驶问卷，亚组 106 名患者接受了心理肝脏脑病评分（PHES）和脑电图（EEG），根据这些结果，再加上临床评估，他们被归类为未受损（n=51），或有轻微（n=35）或轻度显性 HE（n=20）。所有患者平均随访 13±5 个月，观察与事故和/或交通违法行为、HE 相关住院和死亡有关的情况。66 名健康志愿者按性别、年龄和教育程度平均分配，作为 PVT 的参考队列。
与健康志愿者相比，患者的 PVT 表现更差，且 PVT 指标与 MELD、氨水平、PHES 和 EEG 结果显著相关。神经心理表现/PVT 指标与驾驶执照/驾驶状态之间存在显著关联。PVT、PHES 和 EEG 结果均预测随访期间的 HE 相关住院和/或死亡；无一预测事故或交通违法行为。然而，尽管有驾照，但反应时间最慢且出现最多失误的个体往往没有开车。当因 HE 相关原因停止驾驶的患者（n=6）在随后的 6 和 12 个月被模拟为发生事故或罚款时，PVT 是事故和交通违法行为的预测指标，即使在对 MELD 和年龄进行校正后也是如此。
PVT 值得进一步研究，以评估 HE 和驾驶能力。
背景与目的：肝性脑病（HE）是一种严重肝脏疾病的并发症，可表现为过度嗜睡。一些患有 HE 的患者被发现难以驾驶。在此，我们使用了一种名为精神运动警觉任务（PVT）的测试，该测试可测量嗜睡程度，也可用于评估驾驶能力。我们表明，在健康个体中，PVT 表现相当稳定。我们还表明，PVT 表现与肝硬化患者中常用的用于测量 HE 的测试结果相似。我们建议，该测试有助于量化 HE，并识别肝硬化患者中的危险驾驶员。
