Liver Failure, Cirrhosis and Portal Hypertension
Article first published online: 27 JAN 2012
Copyright © 2011 American Association for the Study of Liver Diseases
Volume 55, Issue 2, pages 530–539, February 2012
How to Cite
Felipo, V., Ordoño, J. F., Urios, A., El Mlili, N., Giménez-Garzó, C., Aguado, C., González-Lopez, O., Giner-Duran, R., Serra, M. A., Wassel, A., Rodrigo, J. M., Salazar, J. and Montoliu, C. (2012), Patients with minimal hepatic encephalopathy show impaired mismatch negativity correlating with reduced performance in attention tests. Hepatology, 55: 530–539. doi: 10.1002/hep.24704
Potential conflict of interest: Nothing to report.
This work was supported by grants from Ministerio de Ciencia Innovacion (SAF2008-00062 and CSD2008-00005, to V.F.; and FIS 06/0065 and PS09/00806, to C.M.), from Consellería Educación (ACOMP-2009-025, ACOMP/2009/191, PROMETEO-2009-027, and ACOMP2010-220), AP-092/09, AP-043-10, and AP-028/10 from Conselleria Sanitat, Generalitat Valenciana, and from Fundacion Mutua Madrileña (to C.M.).
- Issue published online: 27 JAN 2012
- Article first published online: 27 JAN 2012
- Accepted manuscript online: 27 SEP 2011 01:34PM EST
- Manuscript Accepted: 12 SEP 2011
- Manuscript Received: 3 FEB 2011
Attention deficit is an early event in the cognitive impairment of patients with minimal hepatic encephalopathy (MHE). The underlying mechanisms remain unclear. Mismatch negativity (MMN) is an auditory event-related potential that reflects an attentional trigger. Patients with schizophrenia show impaired attention and cognitive function, which are reflected in altered MMN. We hypothesized that patients with MHE, similarly to those with schizophrenia, should show MMN alterations related with attention deficits. The aims of this work were to assess whether (1) MMN is altered in cirrhotic patients with MHE, compared to those without MHE, (2) MMN changes in parallel with performance in attention tests and/or MHE in a longitudinal study, and (3) MMN predicts performance in attention tests and/or in the Psychometric Hepatic Encephalopathy Score (PHES). We performed MMN analysis as well as attention and coordination tests in 34 control subjects and in 37 patients with liver cirrhosis without MHE and 23 with MHE. Patients with MHE show reduced performance in selective and sustained attention tests and in visuomotor and bimanual coordination tests. The MMN wave area was reduced in patients with MHE, but not in those without MHE. In the longitudinal study, MMN area improved in parallel with performance in attention tests and PHES in 4 patients and worsened in parallel in another 4. Logistic regression analyses showed that MMN area predicts performance in attention tests and in PHES, but not in other tests or critical flicker frequency. Receiver operating characteristic curve analyses showed that MMN area predicts attention deficits in the number connection tests A and B, Stroop tasks, and MHE, with sensitivities of 75%-90% and specificities of 76%-83%. Conclusion: MMN area is useful to diagnose attention deficits and MHE in patients with liver cirrhosis. (HEPATOLOGY 2012;)