Proposal of Stroop test cut-off values as screening for neuropsychological impairments in cirrhosis: A Japanese multicenter study.
Stroop test
covert hepatic encephalopathy
liver cirrhosis
neuropsychological test
Journal
Hepatology research : the official journal of the Japan Society of Hepatology
ISSN: 1386-6346
Titre abrégé: Hepatol Res
Pays: Netherlands
ID NLM: 9711801
Informations de publication
Date de publication:
Jun 2021
Jun 2021
Historique:
revised:
01
02
2021
received:
08
12
2020
accepted:
10
02
2021
pubmed:
23
2
2021
medline:
23
2
2021
entrez:
22
2
2021
Statut:
ppublish
Résumé
Despite its relevant clinical impact and high prevalence, covert hepatic encephalopathy (HE) still remains underdiagnosed. As patients with liver cirrhosis tend to be older in Japan, more suitable tests for the elderly and cut-off values based on this attribute are needed. Recently, a Stroop test has been developed and validated for the screening and diagnosis of covert HE in the United States. The present study aims to establish the cut-off values of the Stroop test to screen covert HE. This study was a prospective multicenter cross-sectional endeavor. We undertook a survey of 311 cirrhotic patients, administering the number connection test (NCT)-A and -B and the Stroop-off and -on test. We determined the cut-off values of Stroop test results for cirrhotic patients in a variety of age ranges. The cut-off value of the Stroop test was strongly correlated with age. There was a significant correlation between the results of NCT-B and age, and Stroop-on test results showed a correlation with serum albumin (Alb) levels. Serum Alb ≤3.2 g/dl could have the potential to be an objective biomarker of covert HE. In addition, stepwise logistic regression analysis revealed a relationship between the results of the Stroop-on test and plasma ammonia levels. We established the cut-off values of Stroop test results and confirmed the efficacy of the Stroop test as a simple tool for assessing cognitive alterations. The Stroop test could be suitable as a necessary minimum for the diagnosis of covert HE.
Types de publication
Journal Article
Langues
eng
Pagination
674-681Subventions
Organisme : the Japanese Ministry of Health and Labor and Welfare Sciences Research
ID : Grant ID: 201921009A
Organisme : the Japanese Ministry of Health and Labor and Welfare Sciences Research
ID : 201921009A
Informations de copyright
© 2021 The Japan Society of Hepatology.
Références
Maurice J , Pinzani M . The stratification of cirrhosis. Hepatol Res. 2020;50(5):535-41.
Bajaj JS , Cordoba J , Mullen KD , Amodio P , Shawcross DL , Butterworth RF , et al. International society for hepatic encephalopathy and nitrogen metabolism (ISHEN). Review article: the design of clinical trials in hepatic encephalopathy - an international society for hepatic encephalopathy and nitrogen metabolism (ISHEN) consensus statement. Aliment Pharmacol Ther. 2011;33(7):739-47.
Riggio O , Amodio P , Farcomeni A , Merli M , Nardelli S , Pasquale C , et al. A model for predicting development of overt hepatic encephalopathy in patients with cirrhosis. Clin Gastroenterol Hepatol. 2015;13(7):1346-52.
Xiao G , Ye Q , Han T , Yan J , Sun L , Wang F . Study of the sleep quality and psychological state of patients with hepatitis B liver cirrhosis. Hepatol Res. 2018;48(3):E275-E282.
Román E , Córdoba J , Torrens M , Torras X , Villanueva C , Vargas V , et al. Minimal hepatic encephalopathy is associated with falls. Am J Gastroenterol. 2011;106(3):476-82.
Bajaj JS , Saeian K , Schubert CM , Hafeezullah M , Franco J , Varma RR , et al. Minimal hepatic encephalopathy is associated with motor vehicle crashes: the reality beyond the driving test. Hepatology. 2009;50(4):1175-83.
Ampuero J , Montoliú C , Simón-Talero M , Aguilera V , Millán R , Márquez C , et al. Minimal hepatic encephalopathy identifies patients at risk of faster cirrhosis progression. J Gastroenterol Hepatol. 2018;33(3):718-25.
Kawaguchi T , Konishi M , Kato A , Kato M , Kooka Y , Sawara K , et al. Updating the neuropsychological test system in Japan for the elderly and in a modern touch screen tablet society by resetting the cut-off values. Hepatol Res. 2017;47(12):1335-9.
Fukui H , Saito H , Ueno Y , Uto H , Obara K , Sakaida I , et al. Evidence-based clinical practice guidelines for liver cirrhosis 2015. J Gastroenterol. 2016;51(7):629-50.
Bajaj JS , Heuman DM , Sterling RK , Sanyal AJ , Siddiqui M , Matherly S , et al. Validation of EncephalApp, smartphone-based Stroop test, for the diagnosis of covert hepatic encephalopathy. Clin Gastroenterol Hepatol. 2015;13(10):1828-35.
Yoon EL , Jun DW , Jeong JY , Kim TY , Song DS , Ahn SB , et al. Validation of the Korean Stroop test in diagnosis of minimal hepatic encephalopathy. Sci Rep. 2019;9(1):8027.
Wai CT , Greenson JK , Fontana RJ , Kalbfleisch JD , Marrero JA , Conjeevaram HS , et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38(2):518-26.
Peng Y , Qi X , Guo X . Child-Pugh versus MELD score for the assessment of prognosis in liver cirrhosis: a systematic review and meta-analysis of observational studies. Medicine (Baltim). 2016;95(8):e2877
Ayuso C , Rimola J , Vilana R , Burrel M , Darnell A , García-Criado Á , et al. Diagnosis and staging of hepatocellular carcinoma (HCC): current guidelines. Eur J Radiol. 2018;101:72-81.
Ferenci P , Lockwood A , Mullen K , Tarter R , Weissenborn K , Blei AT . Hepatic encephalopathy-definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 2002;35:716-21.
Scarpina F , Tagini S . The Stroop color and word test. Front Psychol. 2017;8:557.
Patidar KR , Bajaj JS . Covert and overt hepatic encephalopathy: diagnosis and management. Clin Gastroenterol Hepatol. 2015;13(12):2048-61.
Bajaj JS , Etemadian A , Hafeezullah M , Saeian K . Testing for minimal hepatic encephalopathy in the United States: an AASLD survey. Hepatology. 2007;45:833-4.
Wuensch T , Ruether DF , Zöllner C , Mueller T , Jung T , Kaffarnik M , et al. Performance characterization of a novel electronic number connection test to detect minimal hepatic encephalopathy in cirrhotic patients. Eur J Gastroenterol Hepatol. 2017;29(4):456-63.
Bamidele OF , Olokoba AB , Bojuwoye MO , Akintayo RO , Bamidele O . Prevalence of minimal hepatic encephalopathy among patients with chronic liver disease in Ilorin, Nigeria. Ghana Med J. 2019;53(4):299-303.
Haraguchi M , Miuma S , Masumoto H , Ichikawa T , Kanda Y , Sasaki R , et al. Bacteroides in colonic mucosa-associated microbiota affects the development of minimal hepatic encephalopathy in patients with cirrhosis. Hepatol Int. 2019;13(4):482-9.
Kawaguchi T , Suzuki F , Imamura M , Murashima N , Yanase M , Mine T , et al. Rifaximin-altered gut microbiota components associated with liver/neuropsychological functions in patients with hepatic encephalopathy: an exploratory data analysis of phase II/III clinical trials. Hepatol Res. 2019;49(4):404-18.
Kircheis G , Fleig WE , Görtelmeyer R , Grafe S , Häussinger D . Assessment of low-grade hepatic encephalopathy: a critical analysis. J Hepatol. 2007;47(5):642-50.
Zeng X , Zhang LY , Liu Q , Lu CH , Wei J , Shi ZW , et al. Combined scores from the EncephalApp Stroop test, number connection test B, and serial dotting test accurately identify patients with covert hepatic encephalopathy. Clin Gastroenterol Hepatol. 2020;18(7):1618-25.
Hashimoto R , Meguro K , Lee E , Kasai M , Ishii H , Yamaguchi S . Effect of age and education on the Trail Making Test and determination of normative data for Japanese elderly people: the Tajiri Project. Psychiatr Clin Neurosci. 2006;60(4):422-8.
Wilde B , Katsounas A . Immune dysfunction and albumin-related immunity in liver cirrhosis. Mediat Inflamm. 2019;2019:7537649.
Iwasa M , Sugimoto R , Mifuji-Moroka R , Hara N , Yoshikawa K , Tanaka H , et al. Factors contributing to the development of overt encephalopathy in liver cirrhosis patients. Metab Brain Dis. 2016;31(5):1151-6.
Greinert R , Ripoll C , Hollenbach M , Zipprich A . Stepwise diagnosis in covert hepatic encephalopathy: critical flicker frequency and MELD-score as a first-step approach. Aliment Pharmacol Ther. 2016;44(5):514-21.
Lee Y , Kim C , Suk KT , Choi HC , Bang CS , Yoon JH , et al. Differences in cognitive function between patients with viral and alcoholic compensated liver cirrhosis. Metab Brain Dis. 2016;31(2):369-76.
Bale A , Pai CG , Shetty S , Balaraju G , Shetty A . Prevalence of and factors associated with minimal hepatic encephalopathy in patients with cirrhosis of liver. J Clin Exp Hepatol. 2018;8(2):156-61.
Miwa T , Hanai T , Maeda T , Ogiso Y , Imai K , Suetsugu A , et al. Zinc deficiency predicts overt hepatic encephalopathy and mortality in liver cirrhosis patients with minimal hepatic encephalopathy. Hepatol Res. 2020. https://doi.org/10.1111/hepr.13601