Psychometric methods for diagnosing and monitoring minimal hepatic encephalopathy: current validation level and practical use

Mads Kingo Guldberg Hansen*, Kristoffer Kjærgaard, Lotte Lindgreen Eriksen, Lea Ladegaard Grønkjær, Anne Catrine Daugaard Mikkelsen, Thomas Damgaard Sandahl, Hendrik Vilstrup, Karen Louise Thomsen, Mette Munk Enok Lauridsen

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review


Hepatic encephalopathy (HE) is cerebral dysfunction caused by liver failure and inflicts 30-40% of patients with liver cirrhosis during their disease course. Clinically manifest HE is often preceded by minimal HE (MHE) — a clinically undetectable cognitive disturbance closely associated with loss of quality of life. Accordingly, detecting and treating MHE improve the patients’ daily functioning and prevent HE-related hospital admissions. The scope of this review article is to create an overview of the validation level and usage of psychometric tests used to detect MHE: Portosystemic hepatic encephalopathy test, continuous reaction time test, Stroop EncephalApp, animal naming test, critical flicker frequency test, and inhibitory control test. Our work is aimed at the clinician or scientist who is about to decide on which psychometric test would fit best in their clinic, cohort, or study. First, we outline psychometric test validation obstacles and requirements. Then, we systematically approach the literature on each test and select well-conducted studies to answer the following questions: • Which percentage of patients with cirrhosis does the test deem as having MHE? • Is the test able to predict clinically manifest HE? • Is there a well-known test-retest variation and inter-observer variation? • Is the test able to detect a treatment response? • Is the test result affected by age, educational level, gender, or comorbidities?

Original languageEnglish
JournalMetabolic Brain Disease
Issue number3
Pages (from-to)589-605
Publication statusPublished - Mar 2022

Bibliographical note

Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.


  • Diagnostic tests
  • Hepatic encephalopathy
  • Liver cirrhosis
  • Psychometric tests
  • Test validation


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