Remote monitoring of cognition in cirrhosis and encephalopathy: future opportunity and challenge

Abstract

Hepatic Encephalopathy (HE) is a critically important complication of chronic liver disease and portal hypertension, but especially in early covert stages remains underdiagnosed and a common cause of hospitalization and morbidity. Defined by often subtle neuropsychiatric changes, significant cognitive deficits have been extensively described. While traditional methods of assessment remain underutilized in practice and subject to significant confounding with other diseases, mobile technology has emerged as a potential future tool to provide simple and dynamic cognitive assessments. This review discusses the proliferation of cognitive assessment tools, describing possible applications in encephalopathy and the challenges such an implementation may face. There are significant potential advantages to assessing cognition in real time in order to aid early detection and intervention and provide a more realistic measurement of real-world function. Despite this, there are issues with reliability, privacy, applicability and more which must be addressed prior to wide proliferation and acceptance for clinical use. Regardless, the rapid uptake of mobile technology in healthcare is likely to have significant implications for the future management of encephalopathy and liver disease at large.

Keywords: Cognition; Encephalopathy; Liver disease; Mobile technology; Portal hypertension; Remote monitoring.

Fig. 1

Hypothetical use of a mobile health platform for cognitive assessment in cirrhosis, leveraging technology to better diagnose and manage encephalopathy. Created with Biorender.com

Fig. 2

Potential applications of mobile and wearable technology to detect various complications of cirrhosis

Fig. 3

Annual publications found in a pubmed.gov search for studies pertaining to "mobile health" and "remote monitoring" by disease state. While disease prevalence plays a role, cirrhosis continues to lag behind other diseases in proliferation of mobile technology