Case Control Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 28, 2016; 8(30): 1262-1268
Published online Oct 28, 2016. doi: 10.4254/wjh.v8.i30.1262
Frontal assessment battery: A tool for screening minimal hepatic encephalopathy?
Karina Zamprogno de Souza, Maria Penha Zago-Gomes
Karina Zamprogno de Souza, Maria Penha Zago-Gomes, the Center of Health Science, Federal University of Espírito Santo, Vitória 29043-900, Brazil
Author contributions: de Souza KZ performed the research and wrote the paper; de Souza KZ and Zago-Gomes MP designed the research and analyzed the data.
Institutional review board statement: The study was reviewed and approved by the ethics committee of the Center of Health Science, Federal University of Espírito Santo.
Informed consent statement: All patients or their legal guardians provided informed written consent.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author at karinaz_med_ufes@yahoo.com.br. Participants gave informed consent for data sharing; however, the presented data are anonymized and the risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Karina Zamprogno de Souza, MD, The Center of Health Science, Federal University of Espírito Santo, Marechal Campos Avenue, Number 1468, Vitória 29043-900, Brazil. karinaz_med_ufes@yahoo.com.br
Telephone: +55-27-996236404 Fax: +55-27-33357215
Received: April 23, 2016
Peer-review started: April 23, 2016
First decision: June 12, 2016
Revised: August 13, 2016
Accepted: August 27, 2016
Article in press: August 29, 2016
Published online: October 28, 2016
Abstract
AIM

To apply the Frontal Assessment Battery to cirrhotic patients with or without overt hepatic encephalopathy (OHE) and controls.

METHODS

The frontal assessment battery (FAB) was applied to 87 patients with liver cirrhosis (16 with and 71 without OHE) and 40 control subjects without cirrhosis treated at the alcohol and liver outpatient clinics and the gastroenterology ward of the Cassiano Antônio de Moraes University Hospital (Hospital Universitário Cassiano Antônio de Moraes - HUCAM), Espírito Santo, Brazil.

RESULTS

The average FAB score was lower for the cirrhotic than for the non-cirrhotic patients (10.6 ± 3.67 vs 12.25 ± 2.72, P = 0.015). The FAB score was lower for the cirrhotic patients with OHE than for the patients without OHE (8.25 ± 4.55 vs 11.14 ± 3.25, P = 0.027). The total FAB score was lower for the cirrhotic patients without OHE than for the non-cirrhotic patients, although this difference was not significant (11.14 ± 3.25 vs 12.25 ± 2.72, P = 0.067). Nevertheless, the difference in the scores on the subtest that assessed the ability to inhibit a response previously conditioned to a stimulus was significant (1.72 ± 0.93 vs 2.2 ± 0.85, P = 0.011).

CONCLUSION

The present study indicates that the FAB is a promising tool for outpatient minimal HE screening and the assessment of HE severity.

Keywords: Executive functions, Frontal lobe, Hepatic encephalopathy, Minimal hepatic encephalopathy, Liver cirrhosis, Frontal assessment battery

Core tip: The diagnosis of hepatic encephalopathy is based on the West Haven classification. Minimal hepatic encephalopathy is defined by cognitive changes in patients with liver cirrhosis or portosystemic shunting without changes in their physical examination. The diagnosis is performed by neurophysiological and/or neuropsychological tests that are difficult to apply and are expensive. The frontal assessment battery (FAB), which is quick and easy to apply, can be used by the clinician. In the present study, the FAB score was lower in cirrhotic patients, especially those with hepatic encephalopathy. The FAB is a promising test for minimal hepatic encephalopathy screening at the bedside and in outpatient clinics.