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.
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: Thomas K Burroughs; James B Wade; Michael S Ellwood; Andrew Fagan; Douglas M Heuman; Michael Fuchs; Jasmohan S Bajaj Journal: Dig Dis Sci Date: 2018-01-08 Impact factor: 3.199
Authors: Jasmohan S Bajaj; Christine M Schubert; Douglas M Heuman; James B Wade; Douglas P Gibson; Allyne Topaz; Kia Saeian; Muhammad Hafeezullah; Debulon E Bell; Richard K Sterling; R Todd Stravitz; Velimir Luketic; Melanie B White; Arun J Sanyal Journal: Gastroenterology Date: 2010-02-20 Impact factor: 22.682
Authors: Jasmohan S Bajaj; Leroy R Thacker; David Leszczyszyn; Samuel A Taylor; Douglas M Heuman; Shekar Raman; Richard K Sterling; Muhammad S Siddiqui; R Todd Stravitz; Arun J Sanyal; Puneet Puri; Velimir Luketic; Scott Matherly; Michael Fuchs; Melanie B White; Nicole A Noble; Ariel B Unser; James B Wade Journal: Clin Gastroenterol Hepatol Date: 2014-08-23 Impact factor: 11.382
Authors: Vishwadeep Ahluwalia; James B Wade; F Gerard Moeller; Melanie B White; Ariel B Unser; Edith A Gavis; Richard K Sterling; R Todd Stravitz; Arun J Sanyal; Mohammad S Siddiqui; Puneet Puri; Velimir Luketic; Douglas M Heuman; Michael Fuchs; Scott Matherly; Jasmohan S Bajaj Journal: Liver Transpl Date: 2015-07-21 Impact factor: 5.799
Authors: Jasmohan S Bajaj; Leroy R Thacker; Douglas M Heuman; Michael Fuchs; Richard K Sterling; Arun J Sanyal; Puneet Puri; Mohammad S Siddiqui; Richard T Stravitz; Iliana Bouneva; Velimir Luketic; Nicole Noble; Melanie B White; Pamela Monteith; Ariel Unser; James B Wade Journal: Hepatology Date: 2013-05-23 Impact factor: 17.425