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Stroop & encephalopathy

Elliot B Tapper, Neehar D Parikh, Akbar K Waljee, Michael Volk, Noelle E Carlozzi, Anna S-F Lok
OBJECTIVES: Minimal hepatic encephalopathy (HE) is common, characterized by deficits in reaction time and executive function, and strongly associated with disability and mortality. Point-of-care diagnostics performed without specialized skills or equipment are now available, albeit with limited data regarding their generalizability. METHODS: We systematically reviewed MEDLINE, EMBASE, Cochrane Library, and Scopus for diagnostic studies of MHE using broad search terms including HE and minimal, covert, or the names of published diagnostic modalities...
April 2018: American Journal of Gastroenterology
Zhe-Ting Yang, Hua-Jun Chen, Qiu-Feng Chen, Hailong Lin
Objective: Patients with cirrhosis often exhibit cognitive deficits, particularly executive dysfunction, which is considered a predictor of overt hepatic encephalopathy (OHE). We examined brain intrinsic networks associated with executive function to investigate the neural basis of this cognitive deficiency in cirrhosis. Methods: Resting-state functional MRI data were acquired from 20 cirrhotic patients and 18 healthy controls. Seed-based correlation analysis was used to identify the three well-known networks associated with executive function, including executive control (ECN), default mode (DMN), and salience (SN) networks...
2018: Frontiers in Neurology
Meera Vyshni Suresh, Barath Jagadisan, Preeti Kandasamy, Gandhipuram Periyasamy Senthilkumar
OBJECTIVES: Minimal hepatic encephalopathy (MHE) has been reported in children with extrahepatic portal vein obstruction (EHPVO). MHE assessment is restricted to research situations as neuropsychiatric tests are time-intensive. Computerized Stroop Test (CST) has been used in cirrhotic adults for MHE screening. The study aims to assess MHE frequency in young Indian children with EHPVO and validate CST for MHE screening in pediatric EHPVO. METHODS: Thirty-seven children with EHPVO between 7 and 12 years of age and 37 age- and sex-matched controls were enrolled...
May 2018: Journal of Pediatric Gastroenterology and Nutrition
Tarana Gupta, Sahaj Rathi, Radha K Dhiman
In cirrhosis of liver, hepatic encephalopathy (HE) has an important impact on health-related quality of life. It is important to define whether HE is episodic, recurrent, or persistent; types A, B, or C; overt HE or covert HE; and spontaneous or precipitated. The overt HE is clinically evident and needs hospitalization. Nonabsorbable disaccharides, rifaximin, and probiotics are proven to be useful in the treatment of overt HE. Covert HE includes both minimal HE and grade I HE. It is not apparent on routine clinical examination...
January 2017: Euroasian journal of hepato-gastroenterology
Chathur Acharya, James B Wade, Andrew Fagan, Melanie White, Edith Gavis, Dinesh Ganapathy, HoChong Gilles, Douglas M Heuman, Jasmohan S Bajaj
After an initial exposure, patients can develop test-taking/learning strategies called the "test sophistication effect." Patients with cirrhosis with prior overt hepatic encephalopathy (OHE) could have persistent learning impairments. The aim was to define learning/test sophistication on EncephalApp (downloadable application) in OHE patients compared with patients without prior overt hepatic encephalopathy (no-OHE) patients and controls cross-sectionally and longitudinally. The EncephalApp Stroop App consists of 2 sections: the easier "Off" run assesses psychomotor speed while the difficult "On" run assesses cognitive flexibility...
November 2017: Liver Transplantation
Dinesh Ganapathy, Chathur Acharya, Jatinder Lachar, Kavish Patidar, Richard K Sterling, Melanie B White, Catherine Ignudo, Swamy Bommidi, John DeSoto, Leroy R Thacker, Scott Matherly, Jawaid Shaw, Mohammad S Siddiqui, Puneet Puri, Arun J Sanyal, Velimir Luketic, Hannah Lee, Richard T Stravitz, Jasmohan S Bajaj
BACKGROUND & AIMS: Readmissions are a major burden in cirrhosis. A proportion of readmissions in cirrhosis, especially because of hepatic encephalopathy (HE) could be avoided through patient and caregiver engagement. We aimed to define the feasibility of using the Patient Buddy App and its impact on 30-day readmissions by engaging and educating cirrhotic inpatients and caregivers in a pilot study. METHODS: Cirrhotic inpatients with caregivers were enrolled and followed for 30 days post-discharge...
December 2017: Liver International: Official Journal of the International Association for the Study of the Liver
Jasmohan S Bajaj
Patient-reported outcomes (PRO) are critical to understand the spectrum of disease in chronic conditions but are often ignored in clinical practice. Cirrhosis, one of the leading causes of morbidity, is associated with severely impaired PROs likely due to covert hepatic encephalopathy (CHE). The clinical relevance and logistic barriers to routine CHE testing led us to develop the "EncephalApp Stroop App", which is now being used to diagnose CHE. The Primer discusses this example which can potentially be applied to other diseases...
April 6, 2017: Clinical and Translational Gastroenterology
Amparo Urios, Alba Mangas-Losada, Carla Gimenez-Garzó, Olga González-López, Remedios Giner-Durán, Miguel A Serra, Enrique Noe, Vicente Felipo, Carmina Montoliu
BACKGROUND & AIMS: Cognitive dysfunction in cirrhotic patients with minimal hepatic encephalopathy (MHE) is associated with falls. Alterations in postural control and stability could contribute to increase falls risk in these patients. We aimed to assess whether postural control and direction-specific limits of stability are altered in cirrhotic patients with MHE compared to patients without MHE and controls. We also assessed if alterations in postural control correlate with neurological impairment and/or blood biomarkers...
July 2017: Liver International: Official Journal of the International Association for the Study of the Liver
Ashleigh L Osborne, Nadia Solowij, Katrina Weston-Green
BACKGROUND AND OBJECTIVES: Cognitive impairment is a core symptom domain of schizophrenia, neurological disorders and substance abuse. It is characterised by deficits in learning, memory, attention and executive functioning and can severely impact daily living. Antipsychotic drugs prescribed to treat schizophrenia provide limited cognitive benefits and novel therapeutic targets are required. Cannabidiol (CBD), a component of the cannabis plant, has anti-inflammatory and antipsychotic-like properties; however, its ability to improve cognitive impairment has not been thoroughly explored...
January 2017: Neuroscience and Biobehavioral Reviews
Andy Liu, Ryan B Perumpail, Radhika Kumari, Zobair M Younossi, Robert J Wong, Aijaz Ahmed
Hepatic encephalopathy (HE) is a major complication of cirrhosis resulting in significant socioeconomic burden, morbidity, and mortality. HE can be further subdivided into covert HE (CHE) and overt HE (OHE). CHE is a subclinical, less severe manifestation of HE and requires psychometric testing for diagnosis. Due to the time consuming screening process and lack of standardized diagnostic criteria, CHE is frequently underdiagnosed despite its recognized role as a precursor to OHE. Screening for CHE with the availability of the Stroop test has provided a pragmatic method to promptly diagnose CHE...
December 18, 2015: World Journal of Hepatology
Sanath Allampati, Andres Duarte-Rojo, Leroy R Thacker, Kavish R Patidar, Melanie B White, Jagpal S Klair, Binu John, Douglas M Heuman, James B Wade, Christopher Flud, Robert O'Shea, Edith A Gavis, Ariel B Unser, Jasmohan S Bajaj
OBJECTIVES: Diagnosing minimal hepatic encephalopathy (MHE) is challenging, and point-of-care tests are needed. Stroop EncephalApp has been validated for MHE diagnosis in single-center studies. The objective of the study was to validate EncephalApp for MHE diagnosis in a multicenter study. METHODS: Outpatient cirrhotics (with/without prior overt hepatic encephalopathy (OHE)) and controls from three sites (Virginia (VA), Ohio (OH), and Arkansas (AR)) underwent EncephalApp and two gold standards, psychometric hepatic encephalopathy score (PHES) and inhibitory control test (ICT)...
January 2016: American Journal of Gastroenterology
Marsha Y Morgan, Piero Amodio, Nicola A Cook, Clive D Jackson, Gerald Kircheis, Mette M Lauridsen, Sara Montagnese, Sami Schiff, Karin Weissenborn
Minimal hepatic encephalopathy is the term applied to the neuropsychiatric status of patients with cirrhosis who are unimpaired on clinical examination but show alterations in neuropsychological tests exploring psychomotor speed/executive function and/or in neurophysiological variables. There is no gold standard for the diagnosis of this syndrome. As these patients have, by definition, no recognizable clinical features of brain dysfunction, the primary prerequisite for the diagnosis is careful exclusion of clinical symptoms and signs...
December 2016: Metabolic Brain Disease
Vicente Felipo, Amparo Urios, Carla Giménez-Garzó, Omar Cauli, Maria-Jesús Andrés-Costa, Olga González, Miguel A Serra, Javier Sánchez-González, Roberto Aliaga, Remedios Giner-Durán, Vicente Belloch, Carmina Montoliu
AIM: To assess whether non invasive blood flow measurement by arterial spin labeling in several brain regions detects minimal hepatic encephalopathy. METHODS: Blood flow (BF) was analyzed by arterial spin labeling (ASL) in different brain areas of 14 controls, 24 cirrhotic patients without and 16 cirrhotic patients with minimal hepatic encephalopathy (MHE). Images were collected using a 3 Tesla MR scanner (Achieva 3T-TX, Philips, Netherlands). Pulsed ASL was performed...
September 7, 2014: World Journal of Gastroenterology: WJG
Jasmohan S Bajaj, Douglas M Heuman, Richard K Sterling, Arun J Sanyal, Muhammad Siddiqui, Scott Matherly, Velimir Luketic, R Todd Stravitz, Michael Fuchs, Leroy R Thacker, HoChong Gilles, Melanie B White, Ariel Unser, James Hovermale, Edith Gavis, Nicole A Noble, James B Wade
BACKGROUND & AIMS: Detection of covert hepatic encephalopathy (CHE) is difficult, but point-of-care testing could increase rates of diagnosis. We aimed to validate the ability of the smartphone app EncephalApp, a streamlined version of Stroop App, to detect CHE. We evaluated face validity, test-retest reliability, and external validity. METHODS: Patients with cirrhosis (n = 167; 38% with overt HE [OHE]; mean age, 55 years; mean Model for End-Stage Liver Disease score, 12) and controls (n = 114) were each given a paper and pencil cognitive battery (standard) along with EncephalApp...
October 2015: Clinical Gastroenterology and Hepatology
Robert S Rahimi, Don C Rockey
PURPOSE OF REVIEW: Hepatic encephalopathy causes significant cognitive impairment and morbidity in patients with cirrhosis; however, hepatic encephalopathy is considered a reversible syndrome once recognized clinically. Although hepatic encephalopathy is not a single clinical entity, the pathophysiology resulting in brain dysfunction is not fully understood, although it is believed that ammonia production is an important contributing factor. The purpose of this review is to highlight studies used to test for hepatic encephalopathy and those utilizing specific new treatments...
May 2014: Current Opinion in Gastroenterology
Erica V Tartaglione, Mark Derleth, Lei Yu, George N Ioannou
OBJECTIVES: We evaluated whether commercially available, computerized "brain-training" games can be used to identify subtle cognitive impairments in patients with cirrhosis. METHODS: We compared patients with cirrhosis who did not have overt encephalopathy (n=31), patients with pre-cirrhotic chronic liver disease (n=28), and normal controls without liver disease (n=16) with respect to their scores on the number connection test-A (NCT-A), the Inhibitory Control Test (ICT), and five, short (∼2...
March 2014: American Journal of Gastroenterology
Laura M Stinton, Saumya Jayakumar
Minimal hepatic encephalopathy (MHE) is the earliest form of hepatic encephalopathy and can affect up to 80% of cirrhotic patients. By definition, it has no obvious clinical manifestation and is characterized by neurocognitive impairment in attention, vigilance and integrative function. Although often not considered to be clinically relevant and, therefore, not diagnosed or treated, MHE has been shown to affect daily functioning, quality of life, driving and overall mortality. The diagnosis of MHE has traditionally been achieved through neuropsychological examination, psychometric tests or the newer critical flicker frequency test...
October 2013: Canadian Journal of Gastroenterology, Journal Canadien de Gastroenterologie
Tetsuro Ishihara, Mizuki Ito, Yoshiki Niimi, Masashi Tsujimoto, Jo Senda, Yoshinari Kawai, Hirohisa Watanabe, Masatoshi Ishigami, Takashi Ito, Hideya Kamei, Yasuharu Onishi, Taro Nakamura, Hidemi Goto, Shinji Naganawa, Tetsuya Kiuchi, Gen Sobue
OBJECTIVE: To elucidate the effect of liver transplantation (LT) on brain dysfunctions in cirrhotic patients who had no clinical evidence of hepatic encephalopathy (HE), we performed a prospective study of voxel-based diffusion tensor imaging (DTI) and detailed cognitive examination. METHODS: We assessed 12 consecutive patients as transplant candidates by DTI, with neurological and cognitive examinations just before and at 6 months after LT. RESULTS: After LT, cirrhotic patients showed significant improvement in visual reproduction, digit symbol, digit span, Stroop test, and Trail-making test scores, suggesting recovery of frontal-temporal function...
November 2013: Clinical Neurology and Neurosurgery
D S Torres, J Abrantes, C E Brandão-Mello
Minimal hepatic encephalopathy is a syndrome caused by liver cirrhosis and accompanied by a broad spectrum of cognitive symptoms. The objective of the present study was to describe the prevalence of minimal hepatic encephalopathy in cirrhotic patients and to compare their cognitive performance with controls using standardized tests. Patients receiving medication or experiencing comorbidities associated with cognitive disorders were excluded. The final cohort was compared with a control-matched group using the Mini-Mental State Examination (MMSE), as well as Simple Drawing, Clock Drawing, Rey Auditory-Verbal Learning Test (RAVLT), Random Letter, Stroop, Trail-Making Test (TMT) A and B, Boston Naming, Category Verbal Fluency, Digit Span, Constructional Praxis, Processing Speed, and Similarities Tests...
September 2013: Metabolic Brain Disease
Jasmohan S Bajaj, Leroy R Thacker, Douglas M Heuman, Michael Fuchs, Richard K Sterling, Arun J Sanyal, Puneet Puri, Mohammad S Siddiqui, Richard T Stravitz, Iliana Bouneva, Velimir Luketic, Nicole Noble, Melanie B White, Pamela Monteith, Ariel Unser, James B Wade
UNLABELLED: Minimal hepatic encephalopathy (MHE) detection is difficult because of the unavailability of short screening tools. Therefore, MHE patients can remain undiagnosed and untreated. The aim of this study was to use a Stroop smartphone application (app) (EncephalApp_Stroop) to screen for MHE. The app and standard psychometric tests (SPTs; 2 of 4 abnormal is MHE, gold standard), psychometric hepatic encephalopathy score (PHES), and inhibitory control tests (ICTs) were administered to patients with cirrhosis (with or without previous overt hepatic encephalopathy; OHE) and age-matched controls from two centers; a subset underwent retesting...
September 2013: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
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