Psychomotor Speed From Minimal Hepatic Encephalopathy Testing Is Associated With Physical Frailty In Patients With End-stage Liver Disease

Introduction

Physical frailty is strongly correlated with reduced cognitive function not only in the elderly but also in patients of all ages with end-stage liver disease (ESLD). The Stroop Color and Word test is a neuropsychological test that assesses the ability to inhibit the cognitive interference that occurs when the processing of one stimulus impedes the simultaneous processing of a second stimulus (the Stroop effect). A smartphone-based version of the Stroop test—Stroop EncephalApp—has been validated in the United States for screening and diagnosis of minimal hepatic encephalopathy (HE). Physical frailty is highly prevalent in ESLD, particularly among patients with HE. The Liver Frailty Index (LFI), a performance-based measure of physical function combining grip strength, chair stands, and balance, is a validated frailty assessment tool for patients with cirrhosis and ESLD. While the LFI comprises tests of physical performance, it might conceivably also capture the contributions of cognitive impairment to physical frailty in ESLD.