Neuropsychological characterization and detection of subclinical hepatic encephalopathy
M. McCrea, J. Cordoba, G. Vessey, A. T. Blei and C. Randolph
Department of Psychiatry, Northwestern University Medical School, Chicago, Ill., USA.
OBJECTIVE: To elucidate the nature of the neuropsychological deficits
associated with subclinical hepatic encephalopathy. DESIGN: Prospective
study comparing the performance of patients with liver disease and
carefully matched normal controls on a short but comprehensive
neuropsychological test battery. SETTING: A university medical center.
PARTICIPANTS: Twenty patients with cirrhosis (10 alcoholic and 10
nonalcoholic) and 20 controls carefully matched on the basis of age, sex,
education, and alcohol history. RESULTS: The cirrhotic patients exhibited
relatively selective deficits in complex attentional and fine motor skills,
with preservation of general intellectual ability, memory, language and
visuospatial perception. CONCLUSIONS: This pattern of neuropsychological
deficits suggests a subcortical pathophysiology, possibly reflecting
involvement of the basal ganglia. These neuropsychological findings are
consistent with recent neuroradiological, electrophysiological, and
neurophysiological research implicating basal ganglia involvement in
cirrhosis.
