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Improving the inhibitory control task to detect minimal hepatic encephalopathy.
Gastroenterology. 2010 Aug; 139(2):510-8, 518.e1-2.G

Abstract

BACKGROUND & AIMS

Quantification of the number of noninhibited responses (lures) in the inhibitory control task (ICT) has been proposed for the diagnosis of minimal hepatic encephalopathy (MHE). We assessed the efficacy of ICT compared with recommended diagnostic standards.

METHODS

We studied patients with cirrhosis and healthy individuals (controls) who underwent the ICT at 2 centers (center A: n=51 patients and 41 controls, center B: n=24 patients and 14 controls). Subjects were evaluated for MHE by psychometric hepatic encephalopathy score (PHES). Patients from center B also were assessed for MHE by critical flicker frequency and spectral electroencephalogram analyses.

RESULTS

Patients with cirrhosis had higher ICT lures (23.2+/-12.8 vs 12.9+/-5.8, respectively, P<.01) and lower ICT target accuracy (0.88+/-0.17 vs 0.96+/-0.03, respectively, P<.01) compared with controls. However, lures were comparable (25.2+/-12.5 vs 21.4+/-13.9, respectively, P=.32) among patients with/without altered PHES (center A). There was a reverse, U-shaped relationship between ICT lure and target accuracy; a variable adjusting lures was devised based on target accuracy (weighted lures at center B). This variable differed between patients with and without MHE. The variable weighted lures was then validated from data collected at center A by receiver operator characteristic curve analysis; it discriminated between patients with and without PHES alterations (area under the curve=0.71+/-0.07). However, target accuracy alone was as effective as a stand-alone variable (area under the curve=0.81+/-0.06).

CONCLUSIONS

The ICT is not useful for the diagnosis of MHE, unless adjusted by target accuracy. Testing inhibition (lures) does not seem to be superior to testing attention (target accuracy) for the detection of MHE.

Authors+Show Affiliations

Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy. piero.amodio@unipd.itNo 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 availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20470775

Citation

Amodio, Piero, et al. "Improving the Inhibitory Control Task to Detect Minimal Hepatic Encephalopathy." Gastroenterology, vol. 139, no. 2, 2010, pp. 510-8, 518.e1-2.
Amodio P, Ridola L, Schiff S, et al. Improving the inhibitory control task to detect minimal hepatic encephalopathy. Gastroenterology. 2010;139(2):510-8, 518.e1-2.
Amodio, P., Ridola, L., Schiff, S., Montagnese, S., Pasquale, C., Nardelli, S., Pentassuglio, I., Trezza, M., Marzano, C., Flaiban, C., Angeli, P., Cona, G., Bisiacchi, P., Gatta, A., & Riggio, O. (2010). Improving the inhibitory control task to detect minimal hepatic encephalopathy. Gastroenterology, 139(2), 510-8, e1-2. https://doi.org/10.1053/j.gastro.2010.04.057
Amodio P, et al. Improving the Inhibitory Control Task to Detect Minimal Hepatic Encephalopathy. Gastroenterology. 2010;139(2):510-8, 518.e1-2. PubMed PMID: 20470775.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improving the inhibitory control task to detect minimal hepatic encephalopathy. AU - Amodio,Piero, AU - Ridola,Lorenzo, AU - Schiff,Sami, AU - Montagnese,Sara, AU - Pasquale,Chiara, AU - Nardelli,Silvia, AU - Pentassuglio,Ilaria, AU - Trezza,Maria, AU - Marzano,Chiara, AU - Flaiban,Cristiana, AU - Angeli,Paolo, AU - Cona,Giorgia, AU - Bisiacchi,Patrizia, AU - Gatta,Angelo, AU - Riggio,Oliviero, Y1 - 2010/05/11/ PY - 2009/12/31/received PY - 2010/03/30/revised PY - 2010/04/29/accepted PY - 2010/5/18/entrez PY - 2010/5/18/pubmed PY - 2010/8/13/medline SP - 510-8, 518.e1-2 JF - Gastroenterology JO - Gastroenterology VL - 139 IS - 2 N2 - BACKGROUND & AIMS: Quantification of the number of noninhibited responses (lures) in the inhibitory control task (ICT) has been proposed for the diagnosis of minimal hepatic encephalopathy (MHE). We assessed the efficacy of ICT compared with recommended diagnostic standards. METHODS: We studied patients with cirrhosis and healthy individuals (controls) who underwent the ICT at 2 centers (center A: n=51 patients and 41 controls, center B: n=24 patients and 14 controls). Subjects were evaluated for MHE by psychometric hepatic encephalopathy score (PHES). Patients from center B also were assessed for MHE by critical flicker frequency and spectral electroencephalogram analyses. RESULTS: Patients with cirrhosis had higher ICT lures (23.2+/-12.8 vs 12.9+/-5.8, respectively, P<.01) and lower ICT target accuracy (0.88+/-0.17 vs 0.96+/-0.03, respectively, P<.01) compared with controls. However, lures were comparable (25.2+/-12.5 vs 21.4+/-13.9, respectively, P=.32) among patients with/without altered PHES (center A). There was a reverse, U-shaped relationship between ICT lure and target accuracy; a variable adjusting lures was devised based on target accuracy (weighted lures at center B). This variable differed between patients with and without MHE. The variable weighted lures was then validated from data collected at center A by receiver operator characteristic curve analysis; it discriminated between patients with and without PHES alterations (area under the curve=0.71+/-0.07). However, target accuracy alone was as effective as a stand-alone variable (area under the curve=0.81+/-0.06). CONCLUSIONS: The ICT is not useful for the diagnosis of MHE, unless adjusted by target accuracy. Testing inhibition (lures) does not seem to be superior to testing attention (target accuracy) for the detection of MHE. SN - 1528-0012 UR - https://www.unboundmedicine.com/medline/citation/20470775/Improving_the_inhibitory_control_task_to_detect_minimal_hepatic_encephalopathy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5085(10)00677-3 DB - PRIME DP - Unbound Medicine ER -