Neuropsychological aspects of portal-systemic encephalopathy

An extensive psychometric test program was performed in 96 patients with pr oven liver cirrhosis and clinical signs of portal hypertension as well as i n 20 patients with alcoholic pancreatitis, in 19 patients without cirrhosis but with alcoholic cerebral atrophy and in 163 normal controls. The study population comprised six groups of subjects as follows: Group 1. 27 patients with non-alcoholic cirrhosis and normal EEG pattern, " 2. 48 patients with alcoholic cirrhosis and normal EEG pattern " 3. 21 patients with cirrhosis and minimal EEG changes " 4. 20 patients with alcoholic pancreatitis " 5. 19 patients without cirrhosis but with alcoholic cerebral atrophy " 6. 163 normal controls. A one way analysis of variances comparing asymptomatic patients (group 1, 2 and 4) with controls (group 6) revealed no significant differences between patients with alcoholic and non-alcoholic cirrhosis, both cirrhotic groups scoring significantly lower than patients with alcoholic pancreatitis and normal controls, who did not differ significantly. Comparing symptomatic pa tients (group 3 and 5) with normal controls both patient groups scored sign ificantly lower than controls, the cirrhotic group (group 3) scoring signif icantly lower than patients with alcoholic cerebral atrophy. A two way anal ysis of variances revealed that in clinically asymptomatic patients cerebra l functional defects revealed by psychometry are only due to cirrhosis and that in patients with clinical evidence of cerebral impairment the factors alcohol and cirrhosis are additive - not synergistic. A multiple group step wise discriminant analysis revealed that tests evaluating psychomotor funct ions contributed most to the discrimination. Especially "line tracing " pro ved to be most sensitive and most specific followed by dexterity, steadines s, aiming, digit symbols in sensitivity and by reaction time, steadiness an d dexterity in specificity. A test program for clinical use is proposed.