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Multidimensional assessment of neuro-psychiatric symptoms in patients with low-grade hepatic encephalopathy: A clinical rating scale

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World Journal of Gastroenterology 2005年第37期11卷 5893-5898页

作者： sergei mechtcheriakov Ivo W Graziadei André Kugener Julia Wiedemann Chantal Galbavy Hartmann Hinterhuber Josef Marksteiner Wolfgang Vogel Department of General Psychiatry Medical University Innsbruck Austria Department of Gastroenterology and Hepatology Medical University Innsbruck Anichstrasse 35 AT-6020 Innsbruck Austria

AIM： To evaluate the feasibility of a new clinical rating scale for a standardized assessment of cirrhosis-associated neuro-psychiatric symptoms. METHODS： Forty patients with liver cirrhosis （LC, with or without low-grade hepatic encephalopathy） were investigated using a clinical neuro-psychiatric rating scale based on a comprehensive list of neurological, psychomotor, cognitive, affective, behavioral symptoms, and symptoms of disturbed bioregulation. RESULTS： The analysis revealed that the majodty of cirrhotic patients showed, besides characteristic neurological symptoms of hepatic encephalopathy, various psychomotor, affective and bioregulatory symptoms （disturbed sleep and sexual dysfunction）. Patients were impaired in the following subscales： sleep and biorhythm disorder （75.0% of patients）, Parkinsonoid symptoms （25.0%）, affective symptoms （17.5%）, and psychomotor retardation （12.5%）. The increase of total neuro-psychiatric clinical score was significantly associated with the degree of hepatic encephalopathy. CONCLUSION： This study suggests that a substantial number of patients with LC and low-grade hepatic encephalopathy manifest various clinical neuro-psychiatric symptoms. The use of a rating scale, which explores clinical dimensions of hepatic encephalopathy, would improve the management of patients with LC.

关键词： Liver cirrhosis Hepatic encephalopathy Neuropsychiatric symptoms Clinical neuro-psychiatric rating Bradykinesia

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Diagnostic value of fine motor deficits in patients with low-grade hepatic encephalopathy

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World Journal of Gastroenterology 2005年第18期11卷 2777-2780页

作者： sergei mechtcheriakov Ivo W. Graziadei Maria Rettenbacher Ingrid Schuster Hartmann Hinterhuber Wolfgang Vogel Josef Marksteiner Department of General Psychiatry Medical University of Innsbruck Anichstrasse 35 A-6020 Innsbruck Austria Department of Gastroenterology and Hepatology Medical University of Innsbruck Anichstrasse 35 A-6020 Innsbruck Austria Department of Biological Psychiatry Medical University of Innsbruck Anichstrasse 35 A-6020 Innsbruck Austria

AIM: The role of motor dysfunction in early diagnosis of low-grade hepatic encephalopathy remains uncertain. We performed a pilot study to comparatively investigate the kinematic characteristics of small and large rapid alternating movements in patients with liver cirrhosis and low-grade hepatic ***: A kinematic analysis of alternating handwriting (7.5 mm) and large drawing movements (DM, 175 mm) was performed in 30 patients with liver cirrhosis (no hepatic encephalopathy: n = 10; minimal hepatic encephalopathy: n = 9; grade I hepatic encephalopathy: n = 11; healthy controls: n = 12). The correlation between kinematic parameters, clinical neuro-psychiatric symptoms of cerebral dysfunction and the grade of encephalopathy was ***: Both movement types, handwriting and drawing, were significantly slower in cirrhotic patients. In contrast to large DM, the deterioration of handwriting movements significantly correlated with the increase of symptoms of motor dysfunction and differentiated significantly within the group of cirrhosis patients corresponding to the degree of hepatic encephalopathy. CONCLUSION: The deterioration of fine motor control is an important symptom of low-grade hepatic encephalopathy. The kinematic analysis of handwriting allows the quantitative analysis of alterations of motor function and is a possible tool for diagnostics and monitoring of motor dysfunction in patients with low-grade hepatic encephalopathy.

关键词： Hepatic encephalopathy Liver cirrhosis Motor dysfunction Handwriting Kinematic analysis

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