NEUROPSYCHOLOGICAL CHARACTERIZATION AND DETECTION OF SUBCLINICAL HEPATIC-ENCEPHALOPATHY

Objective: To elucidate the nature of the neuropsychological deficits associated with subclinical hepatic encephalopathy. Design: Prospectiv e study comparing the performance of patients with liver disease and c arefully matched normal controls on a short but comprehensive neuropsy chological test battery. Setting: A university medical center. Partici pants: Twenty patients with cirrhosis (10 alcoholic and 10 nonalcoholi c) and 20 controls carefully matched on the basis of age, sex, educati on, and alcohol history. Results: The cirrhotic patients exhibited rel atively selective deficits in complex attentional and fine motor skill s, with preservation of general intellectual ability, memory, language , and visuospatial perception. Conclusions: This pattern of neuropsych ological deficits suggests a subcortical pathophysiology, possibly ref lecting involvement of the basal ganglia. These neuropsychological fin dings are consistent with recent neuroradiological, electrophysiologic al, and neurophysiological research implicating basal ganglia involvem ent in cirrhosis.