Minimal hepatic encephalopathy in patients with decompensated liver cirrhosis

Abstract

Minimal hepatic encephalopathy (mHE) is characterized by some minimal unspecific alterations of cerebral functions that can only be detected by neuropsychological or neurophysiological diagnostic tests, which dysfunctions nevertheless interfere with the patient's daily living. Early recognition of these impairments may prevent the progression or delay the development of the disease to overt hepatic encephalopathy. The aim of this study was to diagnose mHE in patients with decompensated liver cirrhosis. The study was conducted in 60 patients aged 40-65, divided into two groups: experimental group and control group. Patients in the experimental group were divided into Child-Pugh groups A, B or C: 53% were classified as Child-Pugh B and 47% as Child-Pugh C. Patients were tested using three neuropsychological tests: Mini Mental Score for quick assessment of cognitive status and two tests specific for mHE changes, Trail Making Test - Part A (TMT-A) and Symbol Digit Test (SDT). Electroencephalography (EEG) was performed in all patients. Limits for completing the test were set by using the formula X(control group) + 2 SD for TMT-A and X(control group) - 2 SD for SDT. All the three tests disclosed statistically significantly different results between the two groups. All patients with cirrhosis had some changes in EEG. Study results showed 80% of cirrhosis patients to have signs of mHE. The Child-Pugh score influenced performance on the neuropsychological tests. SDT more readily identified patients with mHE. Our findings pointed to the frequency of mHE and the importance of early diagnosis in the prevention of mHE progression to overt hepatic encephalopathy.