Masuzaki R, Kogure H. Smartphone-based Stroop Test, EncephalApp: What is the optimal cutoff for diagnosing minimal hepatic encephalopathy? World J Hepatol 2025; 17(3): 101649 [DOI: 10.4254/wjh.v17.i3.101649]
Corresponding Author of This Article
Ryota Masuzaki, MD, PhD, Associate Professor, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nihon University School of Medicine, 30-1, Oyaguchi-Kamicho, Itabashi-ku, Tokyo 176-8610, Japan. masuzaki.ryota@nihon-u.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Mar 27, 2025; 17(3): 101649 Published online Mar 27, 2025. doi: 10.4254/wjh.v17.i3.101649
Smartphone-based Stroop Test, EncephalApp: What is the optimal cutoff for diagnosing minimal hepatic encephalopathy?
Ryota Masuzaki, Hirofumi Kogure
Ryota Masuzaki, Hirofumi Kogure, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo 176-8610, Japan
Author contributions: Masuzaki R wrote the paper; Masuzaki R and Kogure H designed the overall concept and outline of the manuscript; Kogure H supervised the project; all of the authors read and approved the final version of the manuscript to be published.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ryota Masuzaki, MD, PhD, Associate Professor, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nihon University School of Medicine, 30-1, Oyaguchi-Kamicho, Itabashi-ku, Tokyo 176-8610, Japan. masuzaki.ryota@nihon-u.ac.jp
Received: September 23, 2024 Revised: February 4, 2025 Accepted: February 13, 2025 Published online: March 27, 2025 Processing time: 185 Days and 1.5 Hours
Abstract
Jiang et al explored the diagnostic capabilities of EncephalApp, a smartphone-based Stroop Test, in patients with nonalcoholic liver disease. The study included 160 patients with nonalcoholic cirrhosis and utilized the psychometric hepatic encephalopathy score as a benchmark for diagnosing minimal encephalopathy. The identified optimal cutoff times were > 101.93 seconds for the "off" time and > 205.86 seconds for the combined "on + off" time, demonstrating sensitivities of 0.84 and 0.90, and specificities of 0.77 and 0.71, respectively. The findings suggest the necessity of employing different cutoffs for patients with alcoholic vs nonalcoholic liver cirrhosis, reflecting the distinct pathophysiologies underlying each condition. Additionally, alcohol consumption itself may influence Stroop test outcomes. Therefore, it is reasonable to establish separate benchmarks for alcoholic and nonalcoholic cirrhotic patients. Further validation in larger patient cohorts with clinical outcomes is essential. The demand for noninvasive liver disease assessments remains high in clinical practice.
Core Tip: Jiang et al examined the diagnostic performance of EncephalApp, a smartphone-based Stroop Test, in patients with nonalcoholic liver disease. Different etiologies manifest distinct liver damage pathophysiologies, justifying the use of varied cutoffs for alcoholic and nonalcoholic cirrhotic patients. These findings should be confirmed through validation in larger patient cohorts, ideally correlated with clinical outcomes. The clinical need for noninvasive liver disease evaluations continues to be significant.
