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The mind and liver test: a new approach to the diagnosis of minimal hepatic encephalopathy in resource-poor settings.

Das S, Ali SM, Seward J, Venkataraman J - Int J Hepatol (2014)

Bottom Line: Results.Test-retest agreement was high (ICC = 0.89).Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Gastroenterology, Stanley Medical College and Hospital, Chennai 600001, India.

ABSTRACT
Background and Aims. Minimal hepatic encephalopathy (MHE) is diagnosed using neuropsychometric tests or neurophysiological tests that are either inapplicable to illiterate patient population in resource-poor settings or require sophisticated and expensive equipment. The available tests assess discrete domains of mental impairment. Our aim was (a) to design a neuropsychometric test that measures all domains of mental impairment in MHE using one metric; (b) to evaluate its sensitivity, specificity, and reproducibility. Methods. The mind and liver test (MALT), a psychometric test assessing cognition, memory, and psychometric impairment, each on a scale of 20, was designed keeping in mind the requirements of a universal test. 40 cirrhotics and 36 controls were subjected to critical flicker frequency (CFF) and MALT in same sitting. ROC curve was plotted for MALT using CFF as gold standard. Bland-Altman plot was used to find test-retest agreement. Results. CFF values and MALT scores varied significantly between the cases and the controls (P < 0.05). MALT was 94% sensitive and 83% specific. Using ROC with CFF as gold standard, the AUC for diagnosis of MHE using MALT score was 0.89. Test-retest agreement was high (ICC = 0.89). Conclusion. In this pilot study, MALT proved to be highly sensitive, specific, inexpensive, and reproducible.

No MeSH data available.


Related in: MedlinePlus

MALT test board. The test is administered clock-wise starting from Step 1, “Copy the figures.” The red steps test memory, green-cognition, and yellow-psychomotor skills. The scores are noted on instruction cum scoring sheet (Table 2).
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fig1: MALT test board. The test is administered clock-wise starting from Step 1, “Copy the figures.” The red steps test memory, green-cognition, and yellow-psychomotor skills. The scores are noted on instruction cum scoring sheet (Table 2).

Mentions: Two other tests were performed on the MALT board, which could affect the daily activities in MHE. These included (a) divided attention: ability to observe images on the board that were not included as a part of the task; (b) judgment ability: to select the shortest of the three shown paths. Table 1 shows the steps included in the three sections of the test that appear on the MALT board (Figure 1) and the corresponding mental function that each step evaluates. Table 2 shows the instruction cum scoring sheet.


The mind and liver test: a new approach to the diagnosis of minimal hepatic encephalopathy in resource-poor settings.

Das S, Ali SM, Seward J, Venkataraman J - Int J Hepatol (2014)

MALT test board. The test is administered clock-wise starting from Step 1, “Copy the figures.” The red steps test memory, green-cognition, and yellow-psychomotor skills. The scores are noted on instruction cum scoring sheet (Table 2).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4274711&req=5

fig1: MALT test board. The test is administered clock-wise starting from Step 1, “Copy the figures.” The red steps test memory, green-cognition, and yellow-psychomotor skills. The scores are noted on instruction cum scoring sheet (Table 2).
Mentions: Two other tests were performed on the MALT board, which could affect the daily activities in MHE. These included (a) divided attention: ability to observe images on the board that were not included as a part of the task; (b) judgment ability: to select the shortest of the three shown paths. Table 1 shows the steps included in the three sections of the test that appear on the MALT board (Figure 1) and the corresponding mental function that each step evaluates. Table 2 shows the instruction cum scoring sheet.

Bottom Line: Results.Test-retest agreement was high (ICC = 0.89).Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Gastroenterology, Stanley Medical College and Hospital, Chennai 600001, India.

ABSTRACT
Background and Aims. Minimal hepatic encephalopathy (MHE) is diagnosed using neuropsychometric tests or neurophysiological tests that are either inapplicable to illiterate patient population in resource-poor settings or require sophisticated and expensive equipment. The available tests assess discrete domains of mental impairment. Our aim was (a) to design a neuropsychometric test that measures all domains of mental impairment in MHE using one metric; (b) to evaluate its sensitivity, specificity, and reproducibility. Methods. The mind and liver test (MALT), a psychometric test assessing cognition, memory, and psychometric impairment, each on a scale of 20, was designed keeping in mind the requirements of a universal test. 40 cirrhotics and 36 controls were subjected to critical flicker frequency (CFF) and MALT in same sitting. ROC curve was plotted for MALT using CFF as gold standard. Bland-Altman plot was used to find test-retest agreement. Results. CFF values and MALT scores varied significantly between the cases and the controls (P < 0.05). MALT was 94% sensitive and 83% specific. Using ROC with CFF as gold standard, the AUC for diagnosis of MHE using MALT score was 0.89. Test-retest agreement was high (ICC = 0.89). Conclusion. In this pilot study, MALT proved to be highly sensitive, specific, inexpensive, and reproducible.

No MeSH data available.


Related in: MedlinePlus