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

Table 1 Clinical and demographic characteristics of patients with LC

	No. of patients	Percent
Age (mean±SD)Men/women	54.77±10.06
	12/28	70.0/30.0
Etiology
Hepatitis C	14	35
Alcohol-associated	16	40
Autoimmune	4	7.5
Cryptogenic	2	5
Hepatitis B	2	5
Hepatitis C and hepatocellular carcinoma	1	2.5
Polycystic liver disease	1	2.5

Table 2 Frequency of neuro-psychiatric symptoms in patients with LC

	Neuro-psychiatric symptoms	Mode of assessment	Cumulative percent of patients showing slight, moderate, or severe symptoms		Percent of slight symptoms
			%	95%CI
	Adiadochokinesiar		72.5	56.11-85.40	45.0
Neurological and	Bradykinesia	r	75.0	58.8-87.31	50.0
psychomotor symptoms	Dysmetria of upper extremities	r	47.5	31.53-63-87	22.5
	Asterixisr	r	30.0	16.56-46.53	20.0
	Facial and head hypomobility	r	60.0	43.33-75.14	50.0
	Postural tremor	r	32.5	18.57-49.13	30.0
	Increased tendon reflexes	r	45.0	29.26-61.51	35.0
	Dysarthria	r	20.0	9.05-35.65	10.0
	Rigidity	r	25.0	12.69-41.20	22.5
	Gait ataxia	r	37.5	22.73-54.50	27.5
	Oculomotor deficits	r	22.5	10.84-38.45	17.5
	Delay in responding verbally	r	35.0	20.63-51.68	32.5
	Reduced speech velocity	r	22.5	10.84-38.45	20.0
	Reduced modulation of voice	r	40.0	24.86-56.67	37.5
Cognitive symptoms	Memory decline	s/r	57.5	40.89-72.96	35.0
	Attention deficits	s/r	47.5	31.51-63.87	32.5
	Concentration deficits	s/r	45.0	29.26-61.51	30.0
	Impaired apperception	s/r	25.0	12.69-41.20	20.0
	Impaired calculation	r	22.5	10.84-38.45	10.0
Affective symptoms	Energy deficit (lack of drive)	s	65.0	48.32-79.37	30.0
	Affective lability	s/r	52.5	36.13-68.49	25.0
	Depressive mood	s/r	40.0	24.86-56.67	27.5
	Interest deficits	s	32.5	18.57-49.13	12.5
	Anhedonia	s	20.0	9.05-35.65	12.5
	Feeling of loss of feeling	s	25.0	12.69-41.20	25.0
Behavioral symptoms	Reduction of working ability	s	87.5	73.20-95.81	25.0
	Social withdrawal	s	50.0	33.80-66.20	15.0
Bioregulatory symptoms	Recurrent drowsiness	s	82.5	67.22-92.66	15.0
	Impaired sleep initiation	s	62.5	45.80-77.27	25.0
	Increased daily sleep	s	72.5	56.11-85.40	27.5
	Interrupted sleep	s	60.0	43.33-75.14	17.5
	Sexual dysfunction (total)	s	72.5	56.11-85.40	5.0
	Women (n = 12)		66.6	34.89-90.08	16.7
	Men (n = 28)		75.0	55.13-89.21	0.0

CI: confidence interval; r: evaluation by rater; s: assessment based on patient’s self-report.

Table 3 Percentage of patients impaired on different ACIND subscales

Subscales	Symptoms	Percentage of impaired patients (95% CIs)
Sleep and biorhythm	Recurrent drowsiness, impaired sleep initiation, interrupted sleep, increased daily sleep	75.0 (58.80–87.31)
Parkinsonoid	Rigidity1, bradykinesia, adiadochokinesia, facial and head hypomobility	25.03 (12.69–41.20)
Cognitive	Memory decline, impaired apperception, concentration deficits, impaired calculation, attention deficits	25.0 (12.69–41.20)
Affective	Depressive mood1, loss of interest, anhedonia, feeling of loss of feeling, energy deficits, affective lability	17.5 (7.34–32.78)
Psychomotor2	Bradykinesia, facial and head hypomobility, reduced speech velocity, delayed verbal responses	12.5 (4.19–26.80)
Ataxia2	Dysmetria of upper extremities, oculomotor deficits, adiadochokinesia, dysarthria, gait ataxia	12.5 (4.19–26.80)

¹Obligatory symptom;

²patients showing muscular rigidity are excluded;

³patients with average 0.75 or more score points per symptom are included.