Rk. Dhiman et al., FIGURE CONNECTION TEST - A UNIVERSAL TEST FOR ASSESSMENT OF MENTAL STATE, Journal of gastroenterology and hepatology, 10(1), 1995, pp. 14-23
The number connection test (NCT), which assesses the extent of organic
brain damage, has been used extensively to evaluate mental state in p
ortasystemic encephalopathy, but has certain inherent limitations. It
cannot be performed by illiterates and those unfamiliar with Roman alp
hanumeric notations. We, therefore, devised a figure connection test (
FCT) based on the subject's identification of figures rather than alph
abets or numerals. Four variations each of FCT-A (A1-A4) and FCT-B (B1
-B4) employing different motifs were developed and compared with four
variations each of NCT-A (A1-A4) and NCT-B (B1-B4) in groups of health
y volunteers with differing educational status. These volunteer groups
were as follows: postgraduates 64; graduates 66; subgraduates 75; and
illiterates 45. Significant differences in mean scores of various tes
ts were observed between these normal groups. Control values of the te
sts for these groups have been standardized and can serve as nomograms
. The effect of educational attainments on performance of FCT and othe
r psychometric tests was analysed and trail-making tests were validate
d for serial use. The FCT was then prospectively validated on 70 patie
nts (classified for comparison with controls according to educational
status as follows: postgraduates 7; graduates 21; subgraduates 32; and
illiterates 10) with cirrhosis of Liver without overt encephalopathy,
to detect subclinical hepatic encephalopathy. NCT-A was abnormal in 3
1.7%, NCT-B in 38.3%, FCT-A in 42.9% and FCT-B in 28.6% of patients. T
aken together these tests diagnosed subclinical hepatic encephalopathy
in 34 (48.5%) patients. We conclude that FCT is as useful as NCT in d
etecting psychomotor performance defects in cirrhotic patients without
overt encephalopathy.