Source Laboratory of Neurobiology, Centro Investigación Príncipe Felipe, Valencia, Spain.

Attention deficit is an early event in cognitive impairment of patients with minimal hepatic encephalopathy (MHE). The underlying mechanisms remain unclear. Mismatch negativity (MMN) is an auditory event-related potential which reflects attentional trigger. Patients with schizophrenia show impaired attention and cognitive function which are reflected in altered MMN.

We hypothesised that patients with MHE, similarly to those with schizophrenia, should show MMN alterations related with attention deficits. The aims of this work were to assess whether: a) MMN is altered in cirrhotic patients with MHE compared to those without MHE; b) MMN changes in parallel with performance in attention tests and/or MHE in a longitudinal study; c) MMN predicts performance in attention tests and/or in the Psychometric Hepatic Encephalopathy Score (PHES). We performed MMN analysis, attention and coordination tests in 34 control subjects, 37 patients with liver cirrhosis without MHE and 23 with MHE. Patients with MHE show reduced performance in selective and sustained attention tests and in visuo-motor and bimanual coordination tests. The MMN wave area was reduced in patients with MHE but not in those without MHE.

In the longitudinal study MMN area improved in parallel with performance in attention tests and PHES in 4 patients and worsened in parallel in other 4. Logistic regression analyses show that MMN area predicts performance in attention tests and in PHES but not in other tests or critical flicker frequency. Receiver operating characteristic curve analyses show that MMN area predicts attention deficits in the NCT-A, NCT-B and Stroop tasks and MHE with sensitivities of 75-90%, and specificities of 76-83%.

Conclusion: MMN area is useful to diagnose attention deficits and MHE in patients with liver cirrhosis.