STUDY ON THE STERNBERG PARADIGM IN CIRRHOTIC-PATIENTS WITHOUT OVERT HEPATIC-ENCEPHALOPATHY

Memory dysfunction is reported in cirrhotics. The aim of this paper wa s to increase insight into memory function of cirrhotic patients witho ut overt hepatic encephalopathy. Eighty-six consecutive cirrhotics wit hout overt hepatic encephalopathy (aged 54+/-10 yr., mean+/-s.d.) and 28 controls (52+/-10 yr.) with comparable education level were enrolle d. Seventeen patients were class A, 55 class B, 14 class C according t o Child-Pugh classification; 29 had alcoholic cirrhosis. The presence of subclinical signs of central nervous system dysfunction were assess ed by Number Connection Test (NCT) and quantified EEG analysis. Memory scanning was evaluated by reaction times (RTs) in the Sternberg parad igm. MANOVA analysis showed that RTs were higher (F-1,F-99=11, p<0.01) and time outs (TOs) more frequent (F-1,F-110=10, p<0.01) in cirrhotic s than in controls. whereas button press errors (BPEs) did not differ significantly (F-1,F-110=2, p=n.s.). In cirrhotics, an interaction Chi ld-Pugh class x memory set size was found (F-2,F-146=4 p<0.05), showin g exceedingly delayed RTs with greater memory set size in class C pati ents. Patients with altered NCT bad significantly prolonged RTs (F-1,F -71=4, p<0.05) and more TOs (F-1,F-82=11, p<0.01) than patients with n ormal NCT. Cirrhotics with altered EEG had significantly prolonged RTs (F-2,F-70=6, p<0.01). RTs were found to be correlated to alpha relati ve power (r=-0.4, p<0.01) and theta relative power (r=0.4, p<0.01). In conclusion, cirrhotics without over encephalopathy, but with NCT or E EG alterations, perform a computerized digit recognition task more slo wly and with higher TOs than cirrhotic patients with normal NCT or EEG . In severe liver insufficiency (class C cirrhotics) also an impairmen t of memory scanning was detected. Sternberg test performance correlat es with NCT and quantitative EEG parameters.