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. 2017 Sep 6:10:281-289.
doi: 10.2147/IJGM.S140197. eCollection 2017.

A pilot evaluation of a computer-based psychometric test battery designed to detect impairment in patients with cirrhosis

Nicola A Cook  1 , Jin Un Kim  1 , Yasmin Pasha  1 , Mary Me Crossey  1 , Adrian J Schembri  2   3 , Brian T Harel  2   4 , Torben Kimhofer  5 , Simon D Taylor-Robinson  1
Affiliations

A pilot evaluation of a computer-based psychometric test battery designed to detect impairment in patients with cirrhosis

Nicola A Cook et al. Int J Gen Med. .

Abstract

Background: Psychometric testing is used to identify patients with cirrhosis who have developed hepatic encephalopathy (HE). Most batteries consist of a series of paper-and-pencil tests, which are cumbersome for most clinicians. A modern, easy-to-use, computer-based battery would be a helpful clinical tool, given that in its minimal form, HE has an impact on both patients' quality of life and the ability to drive and operate machinery (with societal consequences).

Aim: We compared the Cogstate™ computer battery testing with the Psychometric Hepatic Encephalopathy Score (PHES) tests, with a view to simplify the diagnosis.

Methods: This was a prospective study of 27 patients with histologically proven cirrhosis. An analysis of psychometric testing was performed using accuracy of task performance and speed of completion as primary variables to create a correlation matrix. A stepwise linear regression analysis was performed with backward elimination, using analysis of variance.

Results: Strong correlations were found between the international shopping list, international shopping list delayed recall of Cogstate and the PHES digit symbol test. The Shopping List Tasks were the only tasks that consistently had P values of <0.05 in the linear regression analysis.

Conclusion: Subtests of the Cogstate battery correlated very strongly with the digit symbol component of PHES in discriminating severity of HE. These findings would indicate that components of the current PHES battery with the international shopping list tasks of Cogstate would be discriminant and have the potential to be used easily in clinical practice.

Keywords: Cogstate™; Psychometric Hepatic Encephalopathy Score; cirrhosis; hepatic encephalopathy; minimal hepatic encephalopathy; psychometric testing.

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Conflict of interest statement

Disclosure The abstract of this paper was presented at the International Society for Hepatic Encephalopathy and Nitrogen Metabolism (ISHEN) Conference 2017 as a poster presentation with interim findings. The poster’s abstract was published in Volume 7, Supplement 1 (February 2017) in the Journal of Clinical and Experimental Hepatology (10.1016/j.jceh.2017.01.037). The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Heatmap demonstrating correlations between subtests of the PHES test (x-axis) and subtests of Cogstate battery (y-axis). Abbreviations: CPAL, continuous paired associated learning; DS, digital symbol task; IDN, identification test; ISL, international shopping list; ISLR, international shopping list delayed recall; LT-Error, line tracing test error; LT-Time, line tracing test time; NCT-A, number connection test A; NCT-B, number connection test B; OCL, one card learning; ONB, one back task; PHES, Psychometric Hepatic Encephalopathy Score; SD, serial dotting test; Total.lmW, Cogstate total score using non-negative linear model weighting approach; Total.equalW, Cogstate total score using equal weighting approach.
Figure 2
Figure 2
Evaluation of Cogstate battery utility in mHE diagnosis by equal weights approach (upper panel) and linear model approach (lower panel). Note: The PHES cutoff value for mHE was a score of <−2. Abbreviations: PHES, Psychometric Hepatic Encephalopathy Score; mHE, minimal hepatic encephalopathy.
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