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August 1996

Neuropsychological Characterization and Detection of Subclinical Hepatic Encephalopathy

Author Affiliations

From the Departments of Psychiatry (Drs McCrea and Randolph and Ms Vessey), Medicine (Drs Cordoba and Blei), and Neurology (Dr Randolph), Northwestern University Medical School and Lakeside Veterans Affairs Medical Center, Chicago, Ill.

Arch Neurol. 1996;53(8):758-763. doi:10.1001/archneur.1996.00550080076015

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.