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Reduced white matter microstructural integrity correlates with cognitive deficits in minimal hepatic encephalopathy
  1. Carmina Montoliu1,
  2. Amparo Urios1,
  3. Cristina Forn2,
  4. Javier García-Panach2,
  5. Cesar Avila2,
  6. Carla Gimenez-Garzó3,
  7. Abdallah Wassel4,
  8. Miguel A Serra4,
  9. Remedios Giner-Durán5,
  10. Olga Gonzalez5,
  11. Roberto Aliaga6,
  12. Vicente Belloch6,
  13. Vicente Felipo3
  1. 1Instituto de Investigación Sanitaria -INCLIVA, Valencia, Spain
  2. 2Departmento Psicologia Basica, Clinica y Psicobiologia, Universitat Jaume I, Castellon, Spain
  3. 3Laboratorio de Neurobiología, Centro Investigación Príncipe Felipe de Valencia, Valencia, Spain
  4. 4Grupo Hepatología, Servicio Aparato Digestivo, Hospital Clínico de Valencia, Valencia, Spain
  5. 5Servicio de Digestivo, Hospital Arnau de Vilanova, Valencia, Spain
  6. 6ERESA, Unidad de RM, Valencia, Spain
  1. Correspondence to Dr Carmina Montoliu, Instituto de Investigación Sanitaria, INCLIVA, Avda Blasco Ibañez, 17, 46010 Valencia, Spain;

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We read with interest the article by Goldbecker et al1 comparing the accuracy for the diagnosis of hepatic encephalopathy (HE) of the three most commonly used batteries of psychometric test and critical flicker frequency. They conclude that the Psychometric Hepatic Encephalopathy Score (PHES) battery2 is the most robust method for diagnosis of HE.

As mentioned by Goldbecker et al,1 there is a wide agreement that HE needs to be diagnosed and treated and an increasing body of evidence shows that patients benefit from early treatment of overt and minimal HE (MHE). However, the diagnosis of MHE and lower stages of overt HE strongly depends on the experience of the examiner1 and, as indicated by Ferenci3 in his commentary to the paper of Goldbecker et al,1 psychometric tests are not used routinely in clinical practice for diagnosis of MHE. As a consequence, most patients with MHE (around two million people in USA4 and a similar number in the European Union) remain undiagnosed and untreated. This is an …

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