35 Neuropsychological tests are established, time-tested and domains of cognitive functioning tested by particular tests

are well-characterized. However, these are time-consuming, and their results are influenced by age and educational status. Determining impairment in performance using age- and education-adjusted values of at least two of the following tests is recommended: number connection test-A (NCT-A) or figure connection test-A (FCT-A), number connection test-B (NCT-B), block design test and digit symbol test.2 FCT-A and figure connection test-B (FCT-B) can replace NCT-A and NCT-B, respectively, if there are linguistic or illiteracy concerns.9–11,19,22,38 FCT-A and -B are universally applicable tests to assess the mental state that transcend the barriers of linguistic differences and illiteracy. Clinical significance click here of these tests has been evaluated in a large number of healthy volunteers and patients with MHE.38 The PHES, a standardized test battery including NCT-A and B, the line-tracing test for time (t) and error (e), the serial-dotting test, and the digit symbol test, has been extensively validated in the Spanish, German and Indian populations and can be performed in 15–20 min.20,22,36,37 This battery examines many of the abnormalities seen in patients with MHE, including motor speed and accuracy, visuo-spatial orientation,

visual perception, visual construction, attention, concentration,

and, to a lesser extent, check details C59 wnt in vivo memory. PHES has a prognostic value for the occurrence of bouts of overt HE and mortality in cirrhotic patients.20,22 In an Indian version, NCT-B has been replaced by the FCT-A because of concerns that some patients may be unfamiliar with English alphabets and hence unable to complete NCT-B.38 16 Standard neuropsychological assessment is a time-tested and established methodology for measuring cognitive impairment in patients with MHE. (1b) Changes in EEG/evoked responses are non-specific. Among EEG variations, the most sensitive test is computer-assisted analysis, including the mean dominant EEG frequency and the power of a particular rhythm.39–41 Quantified-EEG has a prognostic value for occurrence of bouts of overt HE and mortality in cirrhotic patients.41 Among evoked responses, the P300 peak obtained in an auditory oddball paradigm is the most sensitive test.17,42–45 These tests can supplement neurological or neuropsychiatric examination. Saxena et al.17 demonstrated that there was a greater likelihood of development of overt HE in cirrhotic patients with abnormal P300 event-related potential latencies and NCT than in patients with no such abnormality. Neurophysiological tests can be used during follow up to demonstrate change in a patient’s condition.