A smartphone app can quickly screen for cognitive dysfunction often found in patients with cirrhosis, according to a new Virginia Commonwealth University study. The cognitive dysfunction, known as minimal hepatic encephalopathy (MHE), has been difficult to diagnose.
Published in the September issue of the journal Hepatology, the study tested the validity of the Stroop smartphone application -- called EncephalApp_Stroop -- as a method to screen for MHE.
Validation of the app as a health care tool opens the door for its use as a point-of-care (POC) instrument that providers can use to quickly, easily and confidently evaluate their patients who may be suffering from MHE.
"This app can be used to rapidly select which patients are likely to benefit from further MHE testing and potential treatment, which has been lacking at this time." said principal investigator Jasmohan Bajaj, M.D., associate professor, Department of Gastroenterology, Hepatology and Nutrition, VCU School of Medicine, who practices at VCU and McGuire VA Medical Centers. "It can be translated into practice by clinic assistants, nurses or other non-MD professionals to add a cost-effective approach to the rapid diagnosis of MHE."
MHE is associated with impaired quality of life, employment and driving capability and a higher risk of progression to overt hepatic encephalopathy, but treatment has not been standard of care in the U.S. partly because MHE testing is not feasible.
The free EncephalApp_Stroop app, which Bajaj developed, utilizes the Stroop task, which is used to evaluate psychomotor speed and cognitive flexibility through identification in various combinations of ink colors and words.
To determine the validity of the app as a health care tool, Bajaj and his team recruited 126 patients with cirrhosis, some of whom had overt hepatic encephalopathy, 51 age-balanced health controls and 43 additional patients with cirrhosis for the prospective validation cohort. They underwent a battery of recommended cognitive tests including the traditional MHE test and the Stroop app evaluation.
The team concluded that the Stroop app is a valid, reliable method for screening for MHE. Use of the app may improve the screening process by making it easier and faster and, subsequently, increase treatment rates in potential patients with MHE.
They suggest further studies evaluating the app's validity in other populations are needed.
- Jasmohan S. Bajaj, Leroy R. Thacker, Douglas M. Heuman, Michael Fuchs, Richard K. Sterling, Arun J. Sanyal, Puneet Puri, Mohammad S. Siddiqui, Richard T. Stravitz, Iliana Bouneva, Velimir Luketic, Nicole Noble, Melanie B. White, Pamela Monteith, Ariel Unser, James B. Wade. The Stroop smartphone application is a short and valid method to screen for minimal hepatic encephalopathy. Hepatology, 2013; 58 (3): 1122 DOI: 10.1002/hep.26309
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