Opinion Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2020; 8(16): 3377-3389
Published online Aug 26, 2020. doi: 10.12998/wjcc.v8.i16.3377
Novel computerized psychometric tests as primary screening tools for the diagnosis of minimal hepatic encephalopathy
Ming Luo, Rui Mu, Jian-Fang Liu, Fei-Hu Bai
Ming Luo, Rui Mu, Jian-Fang Liu, Fei-Hu Bai, Department of Gastroenterology, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan 750021, Ningxia Hui Autonomous Region, China
Author contributions: Bai FH designed the study and outlined the draft; Luo M and Mu R wrote and organized the manuscript; and Liu JF searched the reference materials and contributed to the writing of the manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to declare in relation to this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Fei-Hu Bai, MD, PhD, Chief Doctor, Professor, Department of Gastroenterology, People’s Hospital of Ningxia Hui Autonomous Region, No. 301 Zhengyuan North Street, Jinfeng District, Yinchuan 750021, Ningxia Hui Autonomous Region, China. baifeihu@hotmail.com
Received: April 6, 2020
Peer-review started: April 6, 2020
First decision: April 29, 2020
Revised: May 5, 2020
Accepted: July 15, 2020
Article in press: July 15, 2020
Published online: August 26, 2020
Processing time: 140 Days and 19.7 Hours
Abstract

Minimal hepatic encephalopathy (MHE) is a critical neurocognitive complication of decompensated liver cirrhosis and portosystemic shunting, which results in a wide range of cognitive deficits including impairments in working attention, psychomotor speed, and executive function. Current guidelines have recommended paper-and-pencil psychometric tests for the diagnosis of MHE. Most high-risk cirrhotic patients are required to be examined; however, paper-and-pencil psychometric tests are neither convenient nor rapid to perform in the clinic. Recently, novel computerized psychometric tests, including the inhibitory control test, EncephalApp Stroop App, and critical flicker frequency, have been proven to be rapid, effective, and convenient methods for screening MHE in clinical practice and for identifying high-risk cirrhotic patients for further validation using rigid neuropsychometric examinations. However, diagnostic accuracy of these tests is influenced by educational background, age, and cultural differences. This review summarizes clinical evidence of the application of novel computerized psychometric tests for screening MHE.

Keywords: Minimal hepatic encephalopathy; Diagnosis; Psychometric test; Inhibitory control test; EncephalApp Stroop App; Critical flicker frequency

Core tip: This review summarizes clinical evidence of computerized psychometric tests for screening minimal hepatic encephalopathy (MHE). Computerized psychometric tests are rapid, effective, and convenient methods for screening MHE in clinical practice and for identifying high-risk cirrhotic patients for further validation, which helps facilitate early diagnosis and treatment of MHE. However, calibration and validation of these tests are required to reach more convincing conclusions before their widespread clinical application in cirrhotic patients at risk for MHE.