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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

Intergroup comparison for CFF reading and MALT scores. The panel (a) compares the CFF readings between the controls, the non-MHE cirrhotics, and MHE (+) cirrhotics. The panel (b) compares the MALT scores between the same groups.
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fig3: Intergroup comparison for CFF reading and MALT scores. The panel (a) compares the CFF readings between the controls, the non-MHE cirrhotics, and MHE (+) cirrhotics. The panel (b) compares the MALT scores between the same groups.

Mentions: Using 38 Hz as CFF cut-off for MHE, 16 out of the 40 cirrhotics had MHE (40%), 8 each (50%) belonged to Child Class A and Child Class B. Among the 24 cirrhotics without MHE, 14 (58.33%) belonged to Child A and 10 (41.66%) to Child B at the time of MHE testing. The mean CFF for the cases was 39 ± 4.2 Hz compared to 42 ± 1.9 Hz among the controls (P = 0.00) (Figure 3(a)). The demographic characteristics and the lab parameters of the MHE and non-MHE groups among the cirrhotics or the “cases” are compared in Table 4.


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)

Intergroup comparison for CFF reading and MALT scores. The panel (a) compares the CFF readings between the controls, the non-MHE cirrhotics, and MHE (+) cirrhotics. The panel (b) compares the MALT scores between the same groups.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig3: Intergroup comparison for CFF reading and MALT scores. The panel (a) compares the CFF readings between the controls, the non-MHE cirrhotics, and MHE (+) cirrhotics. The panel (b) compares the MALT scores between the same groups.
Mentions: Using 38 Hz as CFF cut-off for MHE, 16 out of the 40 cirrhotics had MHE (40%), 8 each (50%) belonged to Child Class A and Child Class B. Among the 24 cirrhotics without MHE, 14 (58.33%) belonged to Child A and 10 (41.66%) to Child B at the time of MHE testing. The mean CFF for the cases was 39 ± 4.2 Hz compared to 42 ± 1.9 Hz among the controls (P = 0.00) (Figure 3(a)). The demographic characteristics and the lab parameters of the MHE and non-MHE groups among the cirrhotics or the “cases” are compared in Table 4.

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