Short summary

We want to examine if there is a direct pathophysiological association between the unstable reaction times found in patients with minimal hepatic encephalopthy and EEG-indices. 

Rationale

Liver cirrhosis is often complicated by minimal hepatic encephalopathy (MHE). Patients with MHE have poor quality of life; and a higher risk of falls, traffic accidents, and episodes of overt hepatic encephalopathy as compared to patients who are cognitively unimpaired. MHE is treatable in most cases. Lactulose, branched chain amino acids (BCAA) and rifaximin are currently the available treatment options. By definition MHE is unrecognizable at physical evaluation and must be diagnosed via sensitive psychometric methods. The CRT test is one shuch validtated test and has been used i Denmark for the past 3 decades. The CRT test is simple and quick to perform and this is a major advantage compared to traditional psychometric methods preformed with paper and pencil. The CRT measures instability in motor reaction times to 150 auditory stimuli.

In the study presneted hee we wish to examine if there is a direct assiciation between outlying restion times and EEG alterations. Such an association would strenghten CRT validity. 

We will first do a resting state EEG of 10 minutes and next conduct simultaneus CRT and EEG by a specialized EEG equiptment. 

In our study we use the portosystemic encephalopathy test (PSE test) as a comparator test. We do so because the PSE test is the most widely used psychometric test for MHE internationally and endorsed as a common comparator test by ISHEN (International Society for the study of Hepatic Encephalopathy and Nitrogen Metabolism). This paper-pencil test battery consists of 5 sub tests. Age-adjusted normal values are used to score a patient's performance in the test. The overall score is termed the PHES and a value below -4 is abnormal. For now we have only German normal values. 

Description of the cohort

We will examine:

20 patients with liver cirrhosis and normal cognition as juged by the CRT and PSE tests.

20 patients with abnormal CRT test i.e. minimal hepatic encephalopathy

20 patients with overt hepatic encephalopathy (West Haven grade 1 or 2) 

100 healthy controls to establish a reference material for the PSE-test -  a gold standard psychometric test for minimal hepatic encephalopathy to which we currently have omly German norm values.These data will be pooled with existing PSE-data from 100 healthy controls.

Data and biological material

Data from psychometric tests: CRT test, PSE test and EEG. 

Data from the Sickness Impact Profile questionnaire

Data on age, gender, education, medications, prior hospital admissions, comorbidities, liver disease stage. 

Venous blood samples for future research. 

Collaborating researchers and departments

Department of Gastroenterology and Hepatology, Aalborg University Hospital, 9000 Aalborg, Denmark

• Consultant, PhD Søren S Olesen
• Bioengineer Rasmus Nedergaard
• Professor and Chief Physician Asbjørn M Drewes

Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark

• Professor Hendrik Vilstrup