Chinese guidelines on management of hepatic encephalopathy in cirrhosis

Table 5 Notes on neuropsychological/physiological testing methods in clinical use

Testing methods	Testing purposes	Time	Remarks
Psychological tests
Psychometric hepatic encephalopathy score (PHES)	PHES is an important method for determining cognitive dysfunction and diagnosing MHE in cirrhosis patients	Includes five subtests, namely the number connection test A and B, digit symbol test, line tracing test, and serial dotting test	Pen and paper
			Positives on at least two tests are required for clinical diagnosis
Number connection test A	Ability to concentrate, mental activity speed, can be used for rapid outpatient screening for MHE	30 to 120 s	Correction for age and education level improves accuracy
Number connection test B	Ability to concentrate, mental activity speed, distributed attention ability, can be used for rapid outpatient screening for MHE	1 to 3 min	Psychologist is required
			More complicated than number connection test A
Digit symbol test	Ability to concentrate, mental activity speed, can be used for rapid outpatient screening for MHE	2 min	Psychologist is required
Stroop Smartphone app (Encephal App)	Attention, can be used for rapid outpatient screening for MHE	3 to 5 min	Reliable and easy to use
Repeatable battery for the assessment of neuropsychological status	Compliance and working memory, visual spatial ability, language, cognitive processing speed	25 min	Pen and paper
			Psychologist is required
			ISHEN recommends HE psychometric scores as substitute indicators
Inhibition control test	Attention, reaction inhibition, working memory	15 min	Computer processing
			Patient cooperation is required, and patients must learn before testing
Neurophysiological testing
Flicker fusion frequency	Visual identification, can be used on outpatient basis for HE scores of 2 or lower, value of supplemental diagnosis is low	10 min	Patients must learn before testing
EEG	Generalized brain activity. Suitable for children	Variation	Psychologist and specialized tools are required
Evoked potential	Tests the time difference between electrical stimulation and response	Variation	P300 hearing has been used for the diagnosis of MHE

HE: Hepatic encephalopathy; MHE: Minimal hepatic encephalopathy; ISHEN: International Society for Hepatic Encephalopathy and Nitrogen Metabolism; EEG: Electroencephalography.