A STUDY OF USEFULNESS OF PSYCHOMETRIC TESTS IN DIAGNOSIS OF MINIMAL HEPATIC ENCEPHALOPATHY IN PATIENTS WITH CIRRHOSIS OF LIVER

BACKGROUND Hepatic encephalopathy (HE) is a potentially reversible, metabolically caused disturbance of central nervous system function that occurs in patients with acute or chronic liver disease. It encompasses a board spectrum of neurological symptoms of varying severity and is classified according to clinical symptoms. Minimal hepatic encephalopathy (MHE), previously known as subclinical or latent hepatic encephalopathy, is at the beginning of this spectrum. MHE has a high prevalence among patients with liver cirrhosis (22% to 74%).1 It is defined as HE without symptoms on clinical/neurological examination, but with deficits in some cognitive areas that can only be measured by neuropsychometric testing and critical flicker frequency test. The areas with impairments are attention, visuospatial perception, speed of information processing, especially in the psychomotor area, fine motor skills, and short-term memory leading to impaired quality of life and ability to work associated with driving errors, accidents and further deterioration into overt encephalopathy and thereby with increased mortality. In our study, we study the effectiveness of Psychometric tests and Critical flicker frequency test in detecting minimal hepatic encephalopathy earlier in patients with cirrhosis.' MATERIALS AND METHODS This study has been carried out at the General Medicine OP and wards, Department of MGE OP and wards at Govt. Stanley Hospital, Chennai. Study Period-Six months (From June 2013 to November 2013). Study Design- This is a Prospective Observational Study. CONCLUSION Our study demonstrated the occurrence of Minimal Hepatic Encephalopathy (MHE) in patients with Cirrhosis irrespective of the aetiology even in the presence of stable clinical condition. Both Critical Flicker Frequency (CFF) and Psychometric tests have been found out to be effective in detecting MHE. Psychometric tests have subjective variations due to their age factor, differences in education while CFF Test has no such limitations and more of objective in nature not requiring any educational qualification for undergoing and interpretation of the light stimulus and is reproducible. The detection of MHE in more numbers in our study may be due to higher number of patients with higher classes of Child-Pugh classification. The presence of majority of the patients with Hepatitis B infection is due to our place of study being a tertiary care and a prestigious institute of Gastroenterology. Hence, we would like to recommend the utilisation of Critical Flicker Frequency (CFF) Test as an Outpatient Department based screening procedure and also for the monitoring of patients with cirrhosis yet with a stable clinical condition so as to detect MHE earlier and promptly institute the therapy to avoid the complications.