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Overt hepatic encephalopathy impairs learning on the EncephalApp stroop which is reversible after liver transplantation.
Liver Transpl. 2017 11; 23(11):1396-1403.LT

Abstract

After an initial exposure, patients can develop test-taking/learning strategies called the "test sophistication effect." Patients with cirrhosis with prior overt hepatic encephalopathy (OHE) could have persistent learning impairments. The aim was to define learning/test sophistication on EncephalApp (downloadable application) in OHE patients compared with patients without prior overt hepatic encephalopathy (no-OHE) patients and controls cross-sectionally and longitudinally. The EncephalApp Stroop App consists of 2 sections: the easier "Off" run assesses psychomotor speed while the difficult "On" run assesses cognitive flexibility. For the cross-sectional analysis, outpatients with cirrhosis with/without controlled OHE and healthy controls underwent EncephalApp testing, which requires 5 Off and 5 On runs. We studied the difference in time required between completing trial 1 compared with trial 5 (delta 1-5) in both the On and Off runs in controls, all patients with cirrhosis, and between prior OHE/no-OHE patients with cirrhosis. For the longitudinal analyses, 2 groups of patients with cirrhosis were studied; 1 was administered the EncephalApp ≥ 2 weeks apart, and the second was administered before and 6 months after liver transplantation. The study included 89 controls and 230 patients with cirrhosis (85 prior OHE; Model for End-Stage Liver Disease, 11) with similar age (64 versus 61 years; P = 0.92). Patients with cirrhosis had impaired EncephalApp total times and impaired learning on the On runs compared with controls. OHE patients had worse EncephalApp times and learning with the On runs compared with no-OHE patients, which persisted in the longitudinal cohort. No differences in learning were seen in the Off runs. After transplant, there was restoration of learning capability with the On runs in the OHE patients. In conclusion, cognitive flexibility tested by the EncephalApp On runs improves over time in healthy controls and no-OHE but not prior OHE. Psychomotor speed remains similar over time. The learning impairment manifested by patients with cirrhosis with OHE is restored after transplant. Liver Transplantation 23 1396-1403 2017 AASLD.

Authors+Show Affiliations

Departments of Gastroenterology, Hepatology, and Nutrition.Psychiatry, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA.Departments of Gastroenterology, Hepatology, and Nutrition.Departments of Gastroenterology, Hepatology, and Nutrition.Departments of Gastroenterology, Hepatology, and Nutrition.Departments of Gastroenterology, Hepatology, and Nutrition.Departments of Gastroenterology, Hepatology, and Nutrition.Departments of Gastroenterology, Hepatology, and Nutrition.Departments of Gastroenterology, Hepatology, and Nutrition.

Pub Type(s)

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

Language

eng

PubMed ID

28885772

Citation

Acharya, Chathur, et al. "Overt Hepatic Encephalopathy Impairs Learning On the EncephalApp Stroop Which Is Reversible After Liver Transplantation." Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, vol. 23, no. 11, 2017, pp. 1396-1403.
Acharya C, Wade JB, Fagan A, et al. Overt hepatic encephalopathy impairs learning on the EncephalApp stroop which is reversible after liver transplantation. Liver Transpl. 2017;23(11):1396-1403.
Acharya, C., Wade, J. B., Fagan, A., White, M., Gavis, E., Ganapathy, D., Gilles, H., Heuman, D. M., & Bajaj, J. S. (2017). Overt hepatic encephalopathy impairs learning on the EncephalApp stroop which is reversible after liver transplantation. Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 23(11), 1396-1403. https://doi.org/10.1002/lt.24864
Acharya C, et al. Overt Hepatic Encephalopathy Impairs Learning On the EncephalApp Stroop Which Is Reversible After Liver Transplantation. Liver Transpl. 2017;23(11):1396-1403. PubMed PMID: 28885772.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Overt hepatic encephalopathy impairs learning on the EncephalApp stroop which is reversible after liver transplantation. AU - Acharya,Chathur, AU - Wade,James B, AU - Fagan,Andrew, AU - White,Melanie, AU - Gavis,Edith, AU - Ganapathy,Dinesh, AU - Gilles,HoChong, AU - Heuman,Douglas M, AU - Bajaj,Jasmohan S, PY - 2017/06/26/received PY - 2017/08/24/accepted PY - 2017/9/9/pubmed PY - 2018/6/22/medline PY - 2017/9/9/entrez SP - 1396 EP - 1403 JF - Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society JO - Liver Transpl VL - 23 IS - 11 N2 - After an initial exposure, patients can develop test-taking/learning strategies called the "test sophistication effect." Patients with cirrhosis with prior overt hepatic encephalopathy (OHE) could have persistent learning impairments. The aim was to define learning/test sophistication on EncephalApp (downloadable application) in OHE patients compared with patients without prior overt hepatic encephalopathy (no-OHE) patients and controls cross-sectionally and longitudinally. The EncephalApp Stroop App consists of 2 sections: the easier "Off" run assesses psychomotor speed while the difficult "On" run assesses cognitive flexibility. For the cross-sectional analysis, outpatients with cirrhosis with/without controlled OHE and healthy controls underwent EncephalApp testing, which requires 5 Off and 5 On runs. We studied the difference in time required between completing trial 1 compared with trial 5 (delta 1-5) in both the On and Off runs in controls, all patients with cirrhosis, and between prior OHE/no-OHE patients with cirrhosis. For the longitudinal analyses, 2 groups of patients with cirrhosis were studied; 1 was administered the EncephalApp ≥ 2 weeks apart, and the second was administered before and 6 months after liver transplantation. The study included 89 controls and 230 patients with cirrhosis (85 prior OHE; Model for End-Stage Liver Disease, 11) with similar age (64 versus 61 years; P = 0.92). Patients with cirrhosis had impaired EncephalApp total times and impaired learning on the On runs compared with controls. OHE patients had worse EncephalApp times and learning with the On runs compared with no-OHE patients, which persisted in the longitudinal cohort. No differences in learning were seen in the Off runs. After transplant, there was restoration of learning capability with the On runs in the OHE patients. In conclusion, cognitive flexibility tested by the EncephalApp On runs improves over time in healthy controls and no-OHE but not prior OHE. Psychomotor speed remains similar over time. The learning impairment manifested by patients with cirrhosis with OHE is restored after transplant. Liver Transplantation 23 1396-1403 2017 AASLD. SN - 1527-6473 UR - https://www.unboundmedicine.com/medline/citation/28885772/Overt_hepatic_encephalopathy_impairs_learning_on_the_EncephalApp_stroop_which_is_reversible_after_liver_transplantation_ L2 - https://doi.org/10.1002/lt.24864 DB - PRIME DP - Unbound Medicine ER -