Covert Hepatic Encephalopathy: Does the Mini-Mental State Examination Help?

• Published in: Journal of clinical and experimental hepatology 2014-06, Vol.4 (2), p.89-93
• Main Authors: Corrias, Michela, Turco, Matteo, Rui, Michele D, Gatta, Angelo, Angeli, Paolo, Merkel, Carlo, Amodio, Piero, Schiff, Sami, Montagnese, Sara
• Format: Article
• Language: English
• Subjects: ammonia; cirrhosis; dementia; Endocrinology & Metabolism; Gastroenterology and Hepatology; hepatic encephalopathy; liver; Original
• ISSN: 0973-6883; 2213-3453
• DOI: 10.1016/j.jceh.2013.12.005

Background/objectives The Mini-Mental State Examination (MMSE) has been utilized for the diagnosis of hepatic encephalopathy (HE). However, its threshold of abnormality has not been formally tested in patients with cirrhosis and its diagnostic/prognostic validity remains unknown. The aim of this study was to assess it in a large group of well-characterized outpatients with cirrhosis and no overt HE. Methods One-hundred-and-ninety-one patients underwent clinical assessment, MMSE, electroencephalography (EEG) and paper-and-pencil psychometry (PHES); 117 were followed up for 8 ± 5 months in relation to the occurrence of HE-related hospitalizations. Results On the day of study, 81 patients (42%) had abnormal EEG and 67 (35%) abnormal PHES; 103 (60%) had a history of HE. Average MMSE was 26.6 ± 3.5; 22 (19%) patients had abnormal MMSE based on the standard threshold of 24. Patients with abnormal EEG/PHES/history of HE had worse MMSE performance than their counterparts with normal tests/negative history (25.7 ± 4.2 vs. 27.3 ± 2.7; P