Original ArticleScreening for minimal hepatic encephalopathy in asymptomatic drivers with liver cirrhosis
Introduction
Minimal hepatic encephalopathy (MHE) represents a part of the spectrum of hepatic encephalopathy (HE) in its mildest form [1]. The prevalence of MHE in liver disease has been reported to vary from 30% to 84%, depending on both the tests used and population studied [2]. Patients with MHE have no recognisable clinical symptoms of HE but have only mild cognitive and psychomotor deficits [1], [3]. Furthermore, MHE can have a far-reaching impact on quality of life, ability to function in daily life and progression to overt HE [1]. MHE has an impact on the ability to drive a car and may be a significant factor behind motor car accidents [4].
Many diagnostic techniques including psychometric tests, electroencephalogram and evoked potentials (EP) have been used to detect MHE. Among these tests, only psychometric tests can be easily done in epidemiological studies. The symbol digit test (SDT) and number connection test part A (NCT-A) were reported to have the advantages of simplicity and reliability [5], [6].
The objective of this study was to screen for MHE in drivers with liver cirrhosis from Mansoura, a city in the Nile delta in Egypt with a high prevalence of chronic liver disease.
Section snippets
Patients and methods
From the Hepatology Outpatient Clinic of Mansoura Specialized Medical Hospital a total of 174 consecutive drivers who were seropositive for viral markers and under consideration for antiviral therapy and proved to be cirrhotic were screened for MHE during the period from January 2009 to June 2010. Age range of patients was 23–57 years. The diagnosis of cirrhosis was based on clinical, biochemical and ultrasonographic or liver histological data. Exclusion criteria were overt HE (OHE) or a history
Results
The demographic characteristics of the participants are shown in Table 1; 35 patients did not fulfil the inclusion criteria and were excluded (recent alcohol intake (one patient), patient’s refusal (two patients), age above 60 years (seven patients) and refusal to perform liver biopsy (25 patients)).
A total of 66 patients showed evidence for MHE, while in 73 patients no evidence for MHE could be detected. The clinical and biochemical characteristics of the studied patients are demonstrated in
Discussion
Clinically, patients with MHE appear to be free of neuropsychiatric abnormalities; meanwhile, they exhibit specific, reversible, quantifiable neuropsychiatric and/or electroencephalographic abnormalities [7], [8].
Lack of symptoms, preservation of communication skills, overall intelligence and patient’s unawareness of his/her own disease, a phenomenon known as anosognosia, complicate the process of identifying patients with MHE at the clinical setting.
MHE is defined as the presence of at least
Conflicts of interest
The authors declared that there was no conflict of interest.
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