Lupescu I C, Iacob S, Lupescu I G, Pietrareanu C, Gheorghe L
Neurology Department, Fundeni Clinical Institute, Bucharest, Romania.
"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
Maedica (Bucur). 2023 Mar;18(1):4-11. doi: 10.26574/maedica.2023.18.1.4.
Minimal hepatic encephalopathy (MHE) consists of subtle cognitive deficits that are not apparent on a standard neurological examination. Minimal hepatic encephalopathy has been reported in up to 80% of cirrhotic patients and is associated with decreased job performance, poor driving performance, impaired quality of life, and poor survival. In parallel, brain magnetic resonance imaging (MRI) abnormalities are known to occur in liver cirrhotic patients in the form of T1 globus pallidus hyperintensities. In recent years, a new psychometric test for diagnosing MHE has been developed as an app for smartphones and tablets (EncephalApp Stroop test). A translated version of the app is available in Romanian language. To use EncephalApp Stroop test for MHE diagnosis in our cirrhotic patients; to describe the main brain MRI abnormalities encountered in these patients; and to establish if Stroop test results correlate with imaging findings, clinical neurologic findings, and liver function parameters or prognosis. Cross-sectional study over a one-year period, involving 30 adult patients with liver cirrhosis. Subjects were evaluated through a standard neurological examination, psychometric testing using EncephalApp Stroop test, electroencephalogram and brain MRI. In parallel, 40 adult healthy controls were also recruited and evaluated with the EncephalApp Stroop test using the same methodology. Age distribution was similar between the two groups (p=0.6). The mean age of patients was 50±10 years and that of controls 51±12 years. Mean Stroop result was 171±26 seconds for the patient group and 143±20 seconds for the control group (p<0.0001). There was a direct correlation between Stroop test results and age in the control group (R=0.69, p<0.0001) but not also in the patient group (R=0.28, p=0.13). Statistically significant results were obtained by using the Fischer exact test for both cut-off values: 145 seconds in patients < 45-year-old (p<0.001) and 190 seconds in those ≥45 years-old (p=0.03). MRI T1-hyperintensities of the basal ganglia, blood ammonia levels and electroencephalographic changes were not associated with poorer results. Our pilot study, although small, confirmed that patients with liver cirrhosis may have subtle deficits in cognitive areas like attention, concentration or reaction time. This can be assessed easily with the EncephalApp Stroop test which is readily available for use on smartphones or tablets.
轻微肝性脑病（MHE）由标准神经学检查中不明显的细微认知缺陷组成。据报道，高达80%的肝硬化患者存在轻微肝性脑病，且其与工作表现下降、驾驶能力差、生活质量受损及生存率低有关。同时，已知肝硬化患者会出现脑磁共振成像（MRI）异常，表现为苍白球T1高信号。近年来，一种用于诊断MHE的新心理测量测试已开发成智能手机和平板电脑应用程序（EncephalApp Stroop测试）。该应用程序有罗马尼亚语翻译版本。为了在我们的肝硬化患者中使用EncephalApp Stroop测试诊断MHE；描述这些患者中遇到的主要脑MRI异常；并确定Stroop测试结果是否与影像学表现、临床神经学表现、肝功能参数或预后相关。进行了为期一年的横断面研究，纳入30例成年肝硬化患者。通过标准神经学检查、使用EncephalApp Stroop测试进行心理测量测试、脑电图和脑MRI对受试者进行评估。同时，还招募了40例成年健康对照，并采用相同方法用EncephalApp Stroop测试对其进行评估。两组年龄分布相似（p = 0.6）。患者的平均年龄为50±10岁，对照组为51±12岁。患者组的平均Stroop测试结果为171±26秒，对照组为143±20秒（p<0.0001）。对照组中Stroop测试结果与年龄呈正相关（R = 0.69，p<0.0001），但患者组中无此相关性（R = 0.28，p = 0.13）。对于两个临界值，使用Fisher精确检验均获得了具有统计学意义的结果：45岁以下患者为145秒（p<0.001），45岁及以上患者为190秒（p = 0.03）。基底节的MRI T1高信号、血氨水平和脑电图变化与较差的测试结果无关。我们的初步研究虽然规模较小，但证实了肝硬化患者在注意力、专注力或反应时间等认知领域可能存在细微缺陷。使用EncephalApp Stroop测试可以轻松评估这些缺陷，该测试可在智能手机或平板电脑上方便使用。
