VISUAL-ATTENTION ORIENTING IN LIVER-CIRRHOSIS WITHOUT OVERT HEPATIC-ENCEPHALOPATHY

The attention system in patients with liver cirrhosis has not yet been fully investigated. We therefore studied visual attention orienting i n cirrhotic patients without overt hepatic encephalopathy. Seventy cir rhotic patients without overt hepatic encephalopathy (aged 57+/-10 yr. , mean+/-s.d.) and 55 controls (aged 49+/-12 yr.) were enrolled. Visua l attention orienting was evaluated by a computerized neuropsychologic al test. The Reitan A test, commonly used to detect subclinical hepati c encephalopathy, was used to evaluate mental performance. Psychometri c test scores were reduced in cirrhotics compared to controls (attenti on test: neutral condition =495+/-149 vs. 401+/-98 msec; valid conditi on =434+/-110 vs. 398+/-84 msec; invalid condition =485+/-146 vs. 392/-110 msec; p<0.001; Reitan A test = 52+/-20 vs. 35+/-11 sec., p<0.001 ). The attention effect of the cue was found both in controls and cirr hotics; however, it was significantly higher in cirrhotics than in con trols (61+/-111 vs. 33+/-41 msec; p<0.002). The attention effect was d irectly correlated with Reitan A test (r=0.23, p=0.05) in cirrhotics. In conclusion, in cirrhotic patients without overt hepatic encephalopa thy, visual attention orienting was present and focusing to an indexed location had a higher effect on reaction time compared to controls, p ossibly because of reduced basal arousal.