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Use of ImPACT to Diagnose Minimal Hepatic Encephalopathy: An Accurate, Practical, User-Friendly Internet-Based Neuropsychological Test Battery

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Abstract

Background and Aims

An effective, user-friendly neurocognitive test to diagnose minimal hepatic encephalopathy (MHE) is needed. Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) is a brief, validated, Web-based, neuropsychological test battery resulting in four composite scores [Verbal Memory (VrbM), Visual Memory, Visual Motor Speed (VMS), Reaction Time (RT)]. We compared ImPACT to traditional paper-and-pencil tests in patients at risk for MHE versus controls.

Methods

Ninety cirrhotic patients with no history of overt hepatic encephalopathy were compared with 131 controls on standard psychometric tests (SPT) [Trail Making Test-A, Trail Making Test-B, Digit Symbol Test], 4 ImPACT composite scores, and the Sickness Impact Profile (SIP). MHE+ was defined by a score 2 SD below the normative mean on at least one of the SPT. ImPACT (ImP+) scores of patients were defined as 2 SD from the control mean.

Results

Cirrhotic patients scored more poorly than controls on 3/4 of ImPACT scores: VrbM (78.88 vs. 71.37, p < 0.001), VMS (26.47 vs. 22.68, p < 0.001) and RT (0.89 vs. 1.00, p < 0.01), as well as on all 3 SPT. Of the 90 cirrhotics, 16 (18 %) were MHE+, who performed more poorly (p < 0.001) than patients without MHE on VrbM (58.13 vs. 74.19), VMS (16.77 vs. 23.95) and RT (1.24 vs. 0.95). Of the 90 cirrhotics, 25 (27.8 %) were ImP+. MHE+ and ImP+ patients had increased SIP scores versus controls (p < 0.001).

Conclusions

Compared to paper-and-pencil testing, ImPACT provides a brief, user-friendly, neuropsychological evaluation of MHE. ImPACT could become a new standard for MHE diagnosis.

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Abbreviations

ARSMA-II:

Acculturation rating scale for Mexican Americans-II

DST:

Digit symbol test

ImPACT:

Immediate post-concussion assessment and cognitive testing

MELD:

Model of end-stage liver disease

MHE:

Minimal hepatic encephalopathy

TMT-A:

Trail making test-A

TMT-B:

Trail making test-B

OHE:

Overt hepatic encephalopathy

RT:

Reaction time

SIP:

Sickness impact profile

SPT:

Standard psychometric tests

VisM:

Visual memory

VMS:

Visual motor speed

VrbM:

Verbal memory

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Acknowledgments

Investigator-initiated research grant from Salix Pharmaceuticals. Salix was not involved in protocol design and implementation, data collection, analysis, or interpretation of the study results.

Conflict of interest

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Authors and Affiliations

  1. Division of GI and Liver Diseases, Loma Linda University Medical Center, Loma Linda, CA, USA

    Matthew Tsushima, Nelson Lim & Erika Madrigal

  2. Department of Psychiatry and Psychology, Straub Clinic and Hospital, Honolulu, HI, USA

    William Tsushima

  3. Department of Psychology, Hawaii Pacific University, Honolulu, HI, USA

    Vincent Tsushima

  4. Division of GI and Liver Diseases, Loma Linda VA Medical Center, Loma Linda, CA, USA

    Christian Jackson

  5. Division of GI and Liver Diseases and the Transplantation Institute, Loma Linda University Medical Center, Loma Linda, CA, USA

    Michel Henry Mendler

  6. Division of GI and Liver Diseases, Center for Hepatobiliary Disease and Abdominal Transplantation, UC San Diego Health System, 200W. Arbor Drive, #8413, San Diego, CA, 92101-8413, USA

    Michel Henry Mendler

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Correspondence to Michel Henry Mendler.

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Tsushima, M., Tsushima, W., Tsushima, V. et al. Use of ImPACT to Diagnose Minimal Hepatic Encephalopathy: An Accurate, Practical, User-Friendly Internet-Based Neuropsychological Test Battery. Dig Dis Sci 58, 2673–2681 (2013). https://doi.org/10.1007/s10620-013-2668-z

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