Introduction
Minimal hepatic encephalopathy (MHE) is a subtle neurocognitive disorder associated with liver cirrhosis and portosystemic shunting, often slipping under the detection radar of traditional clinical assessments. The invisibility of MHE’s clinical manifestation presents a challenge to gastroenterologists who rely on early diagnosis for effective treatment. With the advent of technology, the transition from paper-and-pencil psychometric tests to computer-aided assessments has reshaped the screening landscape for MHE, promising greater convenience and accuracy. In this comprehensive report, we explore the progressive shift in diagnostic techniques for MHE and discuss the implications for clinical practice. Additionally, we provide insights into the recent developments discussed in “The Turkish Journal of Gastroenterology” article entitled “Advances in psychometric tests for screening minimal hepatic encephalopathy: From paper-and-pencil to computer-aided assessment.”
The Burden of Minimal Hepatic Encephalopathy
MHE is often misdiagnosed or underdiagnosed, with estimates suggesting that a significant portion of patients with liver cirrhosis experiences this complication (Vilstrup et al., 2014; Basu & Shah, 2015). Cognitive impairments associated with MHE, such as diminished attention span, impaired working memory, and executive dysfunction, negatively impact the quality of life, increase the risk of vehicular accidents, and escalate healthcare costs (Mina et al., 2014; Wang et al., 2013; Bajaj et al., 2007).
Traditional Psychometric Assessment
The employment of conventional paper-and-pencil psychometric tests, like the Psychometric Hepatic Encephalopathy Score (PHES) and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), has been well-documented for diagnosing MHE (Seo et al., 2012; Maldonado-Garza et al., 2011; Randolph et al., 2009). However, these tests often demand considerable time, are influenced by educational and cultural factors, and are burdensome for repeated measurements, which is critical in monitoring disease progression or treatment response (De Rui et al., 2016; Dhiman et al., 2010).
Computer-Aided Psychometric Tests
Recent years have witnessed a seismic shift toward the utilization of computer-aided psychometric tests, which offer quick, objective, and repeatable measures for MHE screening. Among these, the SCAN Test, Cognitive Drug Research assessment battery, inhibitory control test, EncephalApp Stroop App, and critical flicker frequency have garnered attention for their efficacy and user-friendliness (Luo et al., 2020).
EncephalApp Stroop App, for example, taps into smartphone capabilities to evaluate cognitive flexibility and processing speed, yielding reliable results correlating with MHE (Bajaj et al., 2013). The inhibitory control test indicates the patient’s ability to override automated responses, serving as a simple and predictive tool for diagnosing MHE (Bajaj et al., 2007). Critical flicker frequency, on the other hand, assesses the highest frequency at which a flickering light is perceived as continuous, providing a non-intrusive and objective measure of cerebral function impairment (Ampuero et al., 2015; Kircheis et al., 2014).
A paradigm shift in diagnosis
The shift from paper-based to digital assessments signifies a crucial development in diagnosing MHE. These novel methods underscore the importance of refining diagnostic accuracy and enhancing the patient experience. Advancements in computer technology facilitate regular monitoring of cognitive function. They provide healthcare professionals with robust and real-time data to make informed clinical decisions (Dhiman et al., 2010; Amodio et al., 2010). The implications extend beyond clinical settings, influencing driving regulations and public safety measures for individuals with MHE (Bajaj et al., 2009; Bajaj et al., 2012).
Recommendations for Clinical Practice
Incorporating these computer-aided tools into clinical practice demands minimal training and can be seamlessly integrated into routine patient evaluations. It is recommended that healthcare practitioners adopt these technologies to improve early detection rates and personalize treatment strategies for MHE (Luo et al., 2020).
Conclusion
The journey from paper-and-pencil to computer-aided psychometric tests for MHE screening is an emblem of progress within gastroenterology. As we embrace digital innovation, we must continue to validate these tools across diverse populations to ensure their universal applicability and work towards developing even more precise and convenient diagnostic strategies for MHE.
Digital Object Identifier (DOI): 10.5152/tjg.2019.18226
References
1. Vilstrup, H., Amodio, P., Bajaj, J., et al. (2014). Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology, 60(3), 715–735. https://doi.org/10.1002/hep.27210
2. Luo, M., Ma, P., Li, L., & Cao, W. (2020). Advances in psychometric tests for screening minimal hepatic encephalopathy: From paper-and-pencil to computer-aided assessment. The Turkish Journal of Gastroenterology, 31(5), 398–407. https://doi.org/10.5152/tjg.2019.18226
3. Bajaj, J. S., Saeian, K., Verber, M. D., et al. (2007). Inhibitory control test is a simple method to diagnose minimal hepatic encephalopathy and predict the development of overt hepatic encephalopathy. American Journal of Gastroenterology, 102(4), 754–760. https://doi.org/10.1111/j.1572-0241.2007.01048.x
4. Ampuero, J., Simon, M., Montoliu, C., et al. (2015). Minimal hepatic encephalopathy and critical flicker frequency are associated with survival of patients with cirrhosis. Gastroenterology, 149(6), 1483–1489. https://doi.org/10.1053/j.gastro.2015.07.067
5. Bajaj, J. S., Thacker, L. R., Heuman, D. M., et al. (2013). The Stroop smartphone application is a short and valid method to screen for minimal hepatic encephalopathy. Hepatology, 58(4), 1122–1132. https://doi.org/10.1002/hep.26309
Keywords
1. Minimal Hepatic Encephalopathy
2. Computer-Aided Psychometric Tests
3. Liver Cirrhosis Cognitive Impairment
4. Hepatic Encephalopathy Screening
5. Digital Neuropsychological Assessment