Hepatic encephalopathy (HE), corresponding to all the neurocognitive symptoms caused by
liver damage and/or the presence of portosystemic shunts. HE can take several forms
depending on its intensity, ranging from subtle neuropsychological abnormalities that are
difficult to detect during a routine interview ("minimal" HE, MHE) to temporospatial
disorientation and confusion that can lead to coma ( "overt" HE, OHE). MHE can
significantly impair the quality of life of patients and caregivers; it is associated
with a poorer prognosis of liver pathology and a significantly more frequent occurrence
of OHE. Detection of MHE is complex, and involves the convergence of a large number of
tests recognized as sensitive: venous ammonia level, electroencephalogram, MRI with
spectroscopy, complete neuropsychological assessment. Today, there is no unanimously
recognized Gold Standard.
The objective of this research project is to develop a cognitive test to detect HE
sensitively and specifically, in order to detect HE.
To do this, the investigators will evaluate the qualities of a rapid and accessible test.
It is a test made up of building blocks to assess psychomotor speed, attention, executive
functions and episodic memory. If it proves sensitive and specific enough for the
diagnosis of MHE, it could be disseminated and allow the screening of MHE.
To do this, the investigators will compare the block construction test to other
neuropsychological examinations validated in the diagnosis of MHE (PHES: Psychometric
Hepatic Encephalopathy Score, CFF: Critical Flicker Frequency test, ANT: Animal Naming
Test). These examinations are reference cognitive tests in the diagnosis of MHE, but the
results between these tests diverge and do not currently make it possible to replace all
of the clinical examinations described above. The investigators will also compare the
construction block test to cognitive tests validated for the evaluation of the targeted
cognitive functions (ROCF Rey-Osterrieth complex figure, FCSRT Free and Cued Selective
Reminding test, MCT Mesulam cancelling task). The diagnosis of MHE is based on an
adjudication committee including a multimodal assessment of MHE (brain MRI with
spectroscopy, EEG, blood sample, neuropsychological assessment), allowing the evaluation
of comorbidities such as other factors of brain injury.
Main objective : to evaluate the sensitivity and specificity of the construction test to
the presence of MHE.
Secondary objectives:
Comparison of screening qualities of the construction test to MHE diagnosis
validated tests (PHES, CFF, ANT)
Evaluate the impact of the presence of comorbidities (factors of brain injury) in
the results of the construction test.
Evaluate the psychometric qualities of the construction test compared to validated
neuropsychological tests.
