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Neuropsychological Characterization and Detection of Subclinical Hepatic Encephalopathy

Michael McCrea, PhD; Juan Cordoba, MD; Ginger Vessey; Andres T. Blei, MD; Christopher Randolph, PhD
Arch Neurol. 1996;53(8):758-763. doi:10.1001/archneur.1996.00550080076015.
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Published online

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.

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