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Inhibitory control test for the diagnosis of minimal hepatic encephalopathy.
Gastroenterology. 2008 Nov; 135(5):1591-1600.e1.G

Abstract

BACKGROUND & AIMS

Minimal hepatic encephalopathy (MHE) is difficult to diagnose. The Inhibitory Control Test (ICT) measures response inhibition and has diagnosed MHE with 90% sensitivity and specificity in a selected population; high lure and low target rates indicated poor ICT performance. We studied the reliability and validity of ICT for MHE diagnosis.

METHODS

ICT was compared with a psychometric battery (standard psychometric tests [SPT]) for MHE diagnosis and overt hepatic encephalopathy (OHE) prediction. ICT was administered twice for test-retest reliability, before/after transvenous intrahepatic portosystemic shunting (TIPS), and before/after yogurt treatment. The time taken by 2 medical assistants (MA) to administer ICT was recorded and compared with that of a psychologist for cost analysis.

RESULTS

One hundred thirty-six cirrhotic patients and 116 age/education-matched controls were studied. ICT (>5 lures) had 88% sensitivity for MHE diagnosis with 0.902 area under the curve for receiver operating characteristic. MHE-positive patients had significantly higher ICT lures (11 vs 4, respectively, P = .0001) and lower targets (92% vs 97%, respectively, P = .0001) compared with MHE-negative patients. The test/retest reliability for ICT lures (n = 50, r = 0.90, P = .0001) was high. ICT and SPT were equivalent in predicting OHE (21%). ICT lures significantly worsened after TIPS (n = 10; 5 vs 9, respectively; P = .02) and improved after yogurt supplementation (n = 18, 10 vs 5, respectively; P = .002). The MAs were successfully trained to administer ICT; the time required for test administration and the associated costs were smaller for ICT than for SPT.

CONCLUSIONS

ICT is a sensitive, reliable, and valid test for MHE diagnosis that can be administered inexpensively by MAs.

Authors+Show Affiliations

Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA. jasmohan.bajaj@va.govNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18723018

Citation

Bajaj, Jasmohan S., et al. "Inhibitory Control Test for the Diagnosis of Minimal Hepatic Encephalopathy." Gastroenterology, vol. 135, no. 5, 2008, pp. 1591-1600.e1.
Bajaj JS, Hafeezullah M, Franco J, et al. Inhibitory control test for the diagnosis of minimal hepatic encephalopathy. Gastroenterology. 2008;135(5):1591-1600.e1.
Bajaj, J. S., Hafeezullah, M., Franco, J., Varma, R. R., Hoffmann, R. G., Knox, J. F., Hischke, D., Hammeke, T. A., Pinkerton, S. D., & Saeian, K. (2008). Inhibitory control test for the diagnosis of minimal hepatic encephalopathy. Gastroenterology, 135(5), 1591-e1. https://doi.org/10.1053/j.gastro.2008.07.021
Bajaj JS, et al. Inhibitory Control Test for the Diagnosis of Minimal Hepatic Encephalopathy. Gastroenterology. 2008;135(5):1591-1600.e1. PubMed PMID: 18723018.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Inhibitory control test for the diagnosis of minimal hepatic encephalopathy. AU - Bajaj,Jasmohan S, AU - Hafeezullah,Muhammad, AU - Franco,Jose, AU - Varma,Rajiv R, AU - Hoffmann,Raymond G, AU - Knox,Joshua F, AU - Hischke,Darrell, AU - Hammeke,Thomas A, AU - Pinkerton,Steven D, AU - Saeian,Kia, Y1 - 2008/07/22/ PY - 2008/04/08/received PY - 2008/07/08/revised PY - 2008/07/17/accepted PY - 2008/8/30/pubmed PY - 2008/12/17/medline PY - 2008/8/30/entrez SP - 1591 EP - 1600.e1 JF - Gastroenterology JO - Gastroenterology VL - 135 IS - 5 N2 - BACKGROUND & AIMS: Minimal hepatic encephalopathy (MHE) is difficult to diagnose. The Inhibitory Control Test (ICT) measures response inhibition and has diagnosed MHE with 90% sensitivity and specificity in a selected population; high lure and low target rates indicated poor ICT performance. We studied the reliability and validity of ICT for MHE diagnosis. METHODS: ICT was compared with a psychometric battery (standard psychometric tests [SPT]) for MHE diagnosis and overt hepatic encephalopathy (OHE) prediction. ICT was administered twice for test-retest reliability, before/after transvenous intrahepatic portosystemic shunting (TIPS), and before/after yogurt treatment. The time taken by 2 medical assistants (MA) to administer ICT was recorded and compared with that of a psychologist for cost analysis. RESULTS: One hundred thirty-six cirrhotic patients and 116 age/education-matched controls were studied. ICT (>5 lures) had 88% sensitivity for MHE diagnosis with 0.902 area under the curve for receiver operating characteristic. MHE-positive patients had significantly higher ICT lures (11 vs 4, respectively, P = .0001) and lower targets (92% vs 97%, respectively, P = .0001) compared with MHE-negative patients. The test/retest reliability for ICT lures (n = 50, r = 0.90, P = .0001) was high. ICT and SPT were equivalent in predicting OHE (21%). ICT lures significantly worsened after TIPS (n = 10; 5 vs 9, respectively; P = .02) and improved after yogurt supplementation (n = 18, 10 vs 5, respectively; P = .002). The MAs were successfully trained to administer ICT; the time required for test administration and the associated costs were smaller for ICT than for SPT. CONCLUSIONS: ICT is a sensitive, reliable, and valid test for MHE diagnosis that can be administered inexpensively by MAs. SN - 1528-0012 UR - https://www.unboundmedicine.com/medline/citation/18723018/Inhibitory_control_test_for_the_diagnosis_of_minimal_hepatic_encephalopathy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5085(08)01331-0 DB - PRIME DP - Unbound Medicine ER -