Mini-Mental State Examination in patients with hepatic encephalopathy and liver cirrhosis: a prospective, quantified electroencephalography study

BMC Gastroenterology

Piotr Milkiewicz³  Przemysław Nowacki¹  Maciej Wójcicki³  Małgorzata Milkiewicz⁴  Ewa Wunsch²  Dorota Koziarska¹ 

[1] Department of Neurology, Pomeranian Medical University, ul. Unii Lubelskiej 1, 71-252, Szczecin, Poland;Liver Research Laboratories, Pomeranian Medical University, Al. Powstancow Wlkp. 72, 70-111, Szczecin, Poland;Department of General, Transplant and Liver Surgery of the Medical University of Warsaw, Warsaw, Poland;Medical Biology Laboratory, Pomeranian Medical University, Al. Powstancow Wlkp. 72, 70-111, Szczecin, Poland

关键词: Frequency analysis;    Electroencephalography;    Mini-mental state examination;    Hepatic encephalopathy;    Liver cirrhosis;   

Others  :  857857
DOI  :  10.1186/1471-230X-13-107

 received in 2012-12-15, accepted in 2013-06-28,  发布年份 2013

【 摘 要 】

Background

Mini-Mental State Examination (MMSE) is one of the most commonly used methods in the assessment of cognitive mental status. MMSE has been used in hepatology but its usefulness in the evaluation of hepatic encephalopathy (HE) has never been properly assessed. The aim of the study was to investigate the value of MMSE in detection of HE in patients with cirrhosis.

Methods

One hundred and one consecutive patients with liver cirrhosis underwent neurological examination, MMSE and electroencephalography (EEG). Spectral analysis of EEG was done with calculation of mean dominant frequency (MDF) and relative power of delta, theta, alpha and beta rhythms. Minimal HE was diagnosed in patients with normal neurological status and alterations in spectral EEG. Statistical analysis included Fisher’s exact and Anova analysis. Categorical data were compared using Levene’s test for equality of variances. Correlation-coefficient analysis was performed by the Pearson’s r or Z-test, as needed. Tests performance was assessed by the calculating the area under the ROC curve (AUC) and evaluating its difference from reference area (AUC=0.5). A p value <0.05 was considered statistically significant.

Results

Overt HE was identified in 49 (48.5%) and minimal HE in 22 (21.8%) patients. Although there were significant correlations between both severity of liver disease (Child-Pugh classification), overt HE (West-Haven criteria) and various MMSE items, MDF showed no correlation with any of MMSE items as well as MMSE summary score. MMSE (score and items) did not discriminate patients without HE and minimal HE. The only significant differences between patients without HE and with overt HE were seen in respect of MMSE score (p<0.02), orientation to place (p<0.003), repetition (p<0.01) and complex commands-understanding (p<0.02). Test performance analysis has shown that MMSE has no value as a prediction method in determining minimal HE and in respect of overt HE has a sensitivity of 63% and specificity of 52% by a cut-off level at 27.5 points to diagnose overt HE.

Conclusions

In conclusion, although MMSE score and single items are altered in patients with overt HE, MMSE has no value in the assessment of minimal HE. Because MMSE could be impaired in several cognitive dysfunctions, more specific test should be used for measuring HE.

【 授权许可】

   
2013 Koziarska et al.; licensee BioMed Central Ltd.

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