Changes in early visual perception in patients with minimal hepatic encephalopathy

Abstract

Introduction and Objective: Minimal Hepatic Encephalopathy (MHE) is characterized by very subtle cognitive changes that are diagnosed with the Psychometric hepatic encephalopathy score (PHES) and critical flickering frequency (CFF). Patients with MHE are slower in attention tests evaluated with visual cognitive evocative potentials, which are late indicators. However, it is unknown whether there is also slowness in automatic responses of early visual perception, such as those of stationary visual potential P100. This study aimed to detect early visible changes in patients with minimal hepatic encephalopathy. Materials and Methods: Cirrhotic patients who went to the Liver Clinic of the Gastroenterology Service of the General Hospital of Mexico ''Eduardo Liceaga'' were included. The PHES, CFF test was applied and the electroencephalogram (EEG) was recorded while repeated visual stimuli were presented to obtain the stationary visual potential P100. The trial was approved by the research ethics committee, and informed consent was obtained. Results: Eighty-nine patients with hepatic cirrhosis participated, 54 women (60.7%) with 53 ± 7.9 years of age and 8.3 ± 3.4 years of schooling. 57 patients (64.0%) and 64 FCP-positive (71.9%) were PHES-positive. MHE (PHES and CFF positive) was detected in 53 patients (59.6%). 29 MHE patients and 10 patients with cirrhosis agreed to do the perceptual tests. P100 latency of the visual potential was quantified lower in patients with MHD 113 ± 9 milliseconds than in cirrhotic 94 ± 14 milliseconds. Conclusions: Patients with MHE showed slowness in early perceptual processes that preceded cognitive processes. Funding: Donation by the volunteer ladies of the Hospital General de México “Dr. Eduardo Liceaga.” Declaration of interest: The authors declare no potential conflicts of interest.