DIAGNOSTIC-TOOLS FOR THE DETECTION OF SUBCLINICAL HEPATIC-ENCEPHALOPATHY - COMPARISON OF STANDARD AND COMPUTERIZED PSYCHOMETRIC TESTS WITH SPECTRAL-BEG

The prevalence of subclinical hepatic encephalopathy (SHE) varies acco rding to the diagnostic tool used in its detection. Since a standardis ed approach to the diagnosis of SHE is not yet available, we compared psychometric tests and EEG spectral analysis. On the same day 32 cirrh otic patients without overt hepatic encephalopathy and 18 controls wer e assessed by psychometric tests, both standard and computerized (CPT) , and by EEG spectral analysis (EEG-SA). The CPT, measuring reaction t ime (Rt) and errors (er), were Font, Choice1, Choice2 and Scan test. T he standard psychometric tests were the number connection test (NCT), the Reitan-B test, the Line Tracing Test [for time: LTT(t) and for err ors: LTT(er)], and the Symbol Digit test(SD). Both psychometric tests [Reitan-B test, LTT(er) and CPT but Font (Rt) and Choice2 (er)] and EE G-SA parameters [mean dominant frequency (MDF) and theta power (theta% )] significantly correlated (p < 0.05) with albumin plasma levels. LTT (er), Scan, Font, Choice1 and Choice2 were significantly related to th eta% and MDF. There was no control with positive EEG-SA, though one co ntrol was positive with LTT(t) and with the number of errors made duri ng Font and Scan tests. The percentage of cirrhotics with positive EEG -SA was 34% (CI95% = 19-53), while 9-66% were positive with psychometr ic tests, depending on the test considered. In spite of the correlatio n between neuropsychological and neurophysiological parameters, the di agnostic agreement between EEG-SA and each psychometric test was not h igh. In conclusion: 1) neurophysiological and neuropsychological impai rment in cirrhotics without overt hepatic encephalopathy were found li nked to each other and to hepatic dysfunction; 2) psychometric tests w ere not sufficiently good predictors of EEG alterations; therefore, ne uropsychological tools can not substitute neurophysiological ones to d etect CNS dysfunction in liver disease.