Multi-Sensory Integration Impairment in Patients with Minimal Hepatic Encephalopathy

Paper-and-pencil-based psychometric tests are the gold standard for diagnosis of cognitive dysfunction in liver disease. However, they take time, can be affected by demographic factors, and lack ecological validity. This study explored multi-sensory integration ability to discriminate cognitive dysfunction in cirrhosis. Thirty-two healthy controls and 30 cirrhotic patients were recruited. The sensory integration test presents stimuli from two different modalities (e.g., image/sound) with a short time lag, and subjects judge which stimuli appeared first. Repetitive tests reveal the sensory integration capability. Performance in the sensory integration test, psychometric tests, and functional near-infrared spectroscopy for patients was compared to controls. Sensory integration capability, the perceptual threshold to discriminate the time gap between an image and sound stimulus, was significantly impaired in cirrhotic patients with minimal hepatic encephalopathy (MHE) compared to controls (p<0.01) and non-MHE patients (p<0.01). Sensory integration test showed good correlation with psychometric tests (NCT-A, r=0.383, p=0.002; NCT-B, r=0.450, p<0.01; DST-F, r=-0.322, p=0.011; DST- B, r=-0.384, p=0.002; ACPT, r=-0.467, p<0.01). Psychometric tests were dependent on age and education level, while the sensory integration test was not affected. The sensory integration test, where a cut-off value for the perceptual threshold was 133.3ms, recognized MHE patients at 90% sensitivity and 86.5% specificity.