Computer-adaptive tests detected cognitive impairment in cirrhotic patients
Novel computer-adaptive tests designed to measure cognitive impairment performed better than current methods in distinguishing patients with cirrhosis from those with pre-cirrhotic chronic liver disease and healthy controls in a recent study.
Researchers from the University of Washington and Veterans Affairs Puget Sound Health Care System assessed 75 patients, including those with cirrhosis but without overt hepatic encephalopathy (OHE; n=31; mean age, 61 years), pre-cirrhotic liver disease (n=28; mean age, 52 years) and controls without liver disease (n=16; mean age, 43 years), for early cognitive impairment. They used standard psychometric testing — number connection test-A (NCT-A) and Inhibitory Control Test (ICT) — and compared it with five computer-adaptive tests (CAT) from Lumosity (Lumos Labs). Each 2.5-minute test was administered on an iPad in 2010.
Scoring differences were minimal between patients with cirrhosis and those with pre-cirrhotic disease when measured by NCT or ICT. Both patient groups had worse scores than controls, but were not significant.
By comparison two of the five Lumosity “brain-training” tests — Color Match (P=.009) and Memory Matrix (P=.04) — yielded strong differences between patients with cirrhosis and those with pre-cirrhotic disease after adjustment for age and education. In unadjusted comparisons all Lumosity tests revealed significantly worse scores for patients with cirrhosis compared with the other groups.
In area under the curve used to differentiate cirrhosis from pre-cirrhotic liver disease, ICT measurement was 0.56 (95% CI, 0.41-0.72) and NCT-A was 0.58 (95% CI, 0.43-0.73), indicating no discrimination. Good discrimination was determined by Color Match (0.75; 95% CI, 0.63-0.87) and Memory Matrix (0.77; 95% CI, 0.64-0.9).
“Two of the five computerized ‘brain-training games’ that we evaluated can discriminate patients with cirrhosis without OHE from patients with pre-cirrhotic liver disease,” the researchers concluded. “We believe that these tests, which assess different cognitive domains, should be further evaluated and validated as tests of early neurocognitive impairment in cirrhosis, potentially as components of new batteries of CATs.”
Disclosure: The researchers report no relevant financial disclosures.