신경인지검사를 이용한 최소증상 간성뇌증의 진단 = Neuropsychological Test for the Detection of Minimal Hepatic Encephalopathy

다국어 초록 (Multilingual Abstract)

Background and Objectives：Minimal hepatic encephalopathy (MHE) is assumed to have a negative effect on patient's daily functioning but is difficult to detect with standard clinical examination. This study is designed to elucidate the characteristics of neuropsychological deficits associated with MHE in patients with liver cirrhosis. Methods：We studied 27 patients with clinically proven liver cirrhosis, without clinical signs of encephalopathy and 30 healthy controls without liver disease. Neuropsychological tests employed to detect MHE were auditory verbal learning test (AVLT) of Rey-Kim memory test, trail making test A, B (TMT-A, TMT-B), digit symbol test (DST), digit span test forward and backward (DST-F, DST-B), word fluency test-category (WFT-C), word fluency test-letter (WFT-L), block design test of Wechsler Adult Intelligence Scale-Revised, and Korean version of Boston naming test and pin insertion test (PIT). Korean version of Mini-Mental State Examination (K-MMSE) was also performed in order to evaluate general cognitive functions. Results：Among the neuropsychological tests applied, TMT-A, TMT-B, DST-F, WFT-C, WFT-L, DST and PIT appeared to be significantly different between liver cirrhosis and control group. Patients who had two or more abnormal test results (over or below the mean ±2 S.D. of the control) were considered to have MHE. Seven patients (25.9%) with liver cirrhosis and 1 (3.3%) subject were considered abnormal on the basis of this criteria. Conclusions：The cirrhotic patients have shown relatively selective deficits in complex attention, fine motor skills and psychomotor speed, while general intelligence, memory, language and visuospatial functions were spared. Follow-up of the patients with MHE is necessary to clarify the clinical significance and the diagnostic accuracy of the MHE based on the neuropsychological tests.