Prevalence of latent portasystemic encephalopathy in an unselected population of patients with liver cirrhosis in general practice

Abstract

To evaluate the prevalence of latent PSE in unselected ambulatory patients with liver cirrhosis practicing physicians were asked to perform two non instrumental psychometric tests (number connection test and line tracing test) on patients with clinical signs of liver cirrhosis and portal hypertension. Tests were repeated after 8 weeks of treatment with Lactulose in those patients considered to have latent PSE at the initial evaluation. 296 physicians tested a total of 783 patients, 771 of these could be evaluated. 551 patients (71.5%) were considered to have latent PSE. There was a significant correlation between psychometric test results and biochemical parameters related to liver function. Repeat testing after 8 weeks treatment with Lactulose revealed definite improvement of psychometric test results in 88% of the patients. At the final evaluation only about 30% of the patients fulfilled the criteria of latent PSE. There was a statistically significant albeit weak correlation between changes in biochemical parameters and psychometric improvement. Psychometric testing with simple non instrumental tests proved to be practicable in the office setting.