Medical College of Wisconsin
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Inhibitory control test for the diagnosis of minimal hepatic encephalopathy. Gastroenterology 2008 Nov;135(5):1591-1600.e1



Pubmed ID




Scopus ID

2-s2.0-55249108459   144 Citations


BACKGROUND & AIMS: Minimal hepatic encephalopathy (MHE) is difficult to diagnose. The Inhibitory Control Test (ICT) measures response inhibition and has diagnosed MHE with 90% sensitivity and specificity in a selected population; high lure and low target rates indicated poor ICT performance. We studied the reliability and validity of ICT for MHE diagnosis.

METHODS: ICT was compared with a psychometric battery (standard psychometric tests [SPT]) for MHE diagnosis and overt hepatic encephalopathy (OHE) prediction. ICT was administered twice for test-retest reliability, before/after transvenous intrahepatic portosystemic shunting (TIPS), and before/after yogurt treatment. The time taken by 2 medical assistants (MA) to administer ICT was recorded and compared with that of a psychologist for cost analysis.

RESULTS: One hundred thirty-six cirrhotic patients and 116 age/education-matched controls were studied. ICT (>5 lures) had 88% sensitivity for MHE diagnosis with 0.902 area under the curve for receiver operating characteristic. MHE-positive patients had significantly higher ICT lures (11 vs 4, respectively, P = .0001) and lower targets (92% vs 97%, respectively, P = .0001) compared with MHE-negative patients. The test/retest reliability for ICT lures (n = 50, r = 0.90, P = .0001) was high. ICT and SPT were equivalent in predicting OHE (21%). ICT lures significantly worsened after TIPS (n = 10; 5 vs 9, respectively; P = .02) and improved after yogurt supplementation (n = 18, 10 vs 5, respectively; P = .002). The MAs were successfully trained to administer ICT; the time required for test administration and the associated costs were smaller for ICT than for SPT.

CONCLUSIONS: ICT is a sensitive, reliable, and valid test for MHE diagnosis that can be administered inexpensively by MAs.

Author List

Bajaj JS, Hafeezullah M, Franco J, Varma RR, Hoffmann RG, Knox JF, Hischke D, Hammeke TA, Pinkerton SD, Saeian K


Kia Saeian MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Cross-Sectional Studies
Follow-Up Studies
Hepatic Encephalopathy
Logistic Models
Middle Aged
Neuropsychological Tests
ROC Curve
Reproducibility of Results
Retrospective Studies
Severity of Illness Index
Young Adult
jenkins-FCD Prod-399 190a069c593fb5498b7fcd942f44b7bc9cdc7ea1