Abstract
Attention alterations are reported in cirrhotics. Aiming at clarifying attention functioning in cirrhotics, an inquiry on the functioning of the anterior (AAS) and the posterior (PAS) attention system was performed. Thirty-six cirrhotics without overt hepatic encephalopathy (24 with EEG or TMT-A alterations) and 16 matched control subjects were enrolled. The AAS was studied by the Stroop task measuring selective attention control, the PAS was studied by the Posner task and the Focus task measuring automatic covert orienting and visual focusing of attention respectively.
Cirrhotics presented a task-dependent psychomotor slowing (Stroop > Posner > Focus) with an increased percentage of errors in the incongruent condition of the Stroop task [F(1, 57) = 4.9, p < 0.03]. Class C patients had both a selective slowing [F(1, 33) = 4.3, p < 0.05] and an increased percentage of errors in the incongruent condition [F(1, 34) = 5.1, p < 0.05] compared to Class A–B patients and controls. The patients with an altered EEG performed the Stroop test significantly slowly than those without EEG alterations [F(1, 41) = 8.9, p < 0.01] and with a clear trend for a higher number of errors in the incongruent condition [F(1, 39) = 3.8, p < 0.06]. In contrast, attention orienting and focusing were maintained. In conclusion, the AAS is more sensitive than the PAS to the early stages of hepatic encephalopathy.
Similar content being viewed by others
References
Amodio, P., Marchetti, P., Del Piccolo, F., Sartori, G., Prior, M., Merkel, C., and Gatta, A. (1995). Visual attention orienting in liver cirrhosis without overt hepatic encephalopathy. Metab. Brain Dis. 10:335–345.
Amodio, P., Marchetti, P., Del Piccolo, F., Campo, G., Rizzo, C., Iemmolo, R.M., Gerunda, G., Caregaro, L., Merkel, C., and Gatta, A. (1998). Visual attention in cirrhotic patients: A study on covert visual attention orienting. Hepatology 27:1517–1523.
Amodio, P., Del Piccolo, F., Marchetti, P., Angeli, P., Iemmolo, R., Caregaro, L., Merkel, C., Gerunda, G., and Gatta, A. (1999a). Clinical features and survivial of cirrhotic patients with subclinical cognitive alterations detected by the number connection test and computerized psychometric tests. Hepatology 29:1662–1667.
Amodio, P., Marchetti, P., Del Piccolo, F., de Tourtchaninoff, M., Varghese, P., Zuliani, C., Campo, G., Gatta, A., and Guerit, J.M. (1999b). Spectral versus visual EEG analysis in mild hepatic encephalopathy. Clin. Neurophysiol. 110:1334–1344.
Amodio, P., Wenin, H., Del Piccolo, F., Mapelli, D., Montagnese, S., Pellegrini, A., Musto, C., Gatta, A., and Umilta, C. (2002). Variability of trail making test, symbol digit test and line trait test in normal people. A normative study taking into account age-dependent decline and sociobiological variables. Aging Clin. Exp. Res. 14:117–131.
Benso, F., Turatto, M., Mascetti, G.G., and Umiltà , C. (1998). The time course of attentional focusing. Eur. J. Cogn. Psychol. 10:373–388.
Caregaro, L., Alberino, F., Amodio, P., Merkel, C., Bolognesi, M., Angeli, P., and Gatta, A. (1996). Malnutrition in alcoholic and virus-related cirrhosis. Am. J. Clin. Nutr. 63:602–609.
Corbetta, M. (1998). Frontoparietal cortical networks for directing attention and the eye to visual locations: identical, independent, or overlapping neural systems? Proc. Natl. Acad. Sci. U.S.A. 95:831–838.
Elsass, P., Lund, Y., and Ranek, L. (1978). Encephalopathy in patients with cirrhosis of the liver. A neuropsychological study. Scand. J. Gastroenterol. 13:241–247.
Ferenci, P., Lockwood, A., Mullen, K., Tarter, R., Weissenborn, K., and Blei, A.T. (2002). Hepatic encephalopathy—definition, nomenclature, diagnosis, and quantification: Final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology 35:716–721.
Glaser, M.O., and Glaser, W.R. (1982). Time course analysis of the Stroop phenomenon. J. Exp. Psychol. Hum. Percept. Perform. 8:875–894.
Joebges, E.M., Heidemann, M., Schimke, N., Hecker, H., Ennen, J.C., and Weissenborn, K. (2003). Bradykinesia in minimal hepatic encephalopathy is due to disturbances in movement initiation. J. Hepatol. 38:273–280.
Jonides, J. (1980). Towards a model of the mind’s eye’s movement. Can. J. Psychol. 34:103–112.
Jover, R., Company, L., Gutierrez, A., Zapater, P., Perez-Serra, J., Girona, E., Aparicio, J.R., and Perez-Mateo, M. (2003). Minimal hepatic encephalopathy and extrapyramidal signs in patients with cirrhosis. Am. J. Gastroenterol. 98:1599–1604.
Klem, G.H., Lüders, H.O., Jasper, H.H., and Elger, C. (1999). The ten-twenty electrode system of the International Federation. In (G. Deuschal and A. Eisen, eds.), Recommandations for the Practice of Clinical Neurophysiology: Guidlines of the International Federation of Clinical Neurophysiology, Elsevier, Amsterdam, pp. 3–6.
Krieger, S., Jauss, M., Jansen, O., Theilmann, L., Geissler, M., and Krieger, D. (1996). Neuropsychiatric profile and hyperintense globus pallidus on Tl-weighted magnetic resonance images in liver cirrhosis [see comments]. Gastroenterology 111:147–155.
Lockwood, A.H., Murphy, B.W., Donnelly, K.Z., Mahl, T.C., and Perini, S. (1993). Positron-emission tomographic localization of abnormalities of brain metabolism in patients with minimal hepatic encephalopathy. Hepalology 18:1061–1068.
Lockwood, A.H., Weissenborn, K., Burchert, W., Bokemeyer, M., and Wack, D.S. (1998). Neuropsychological test deficit correlate with alterated cerebral glucose metabolism in patients with non-alcoholic cirrhosis. Neurology 50:A253.
McCrea, M., Cordoba, J., Vessey, G., Blei, A.T., and Randolph, C. (1996). Neuropsychological characterization and detection of subclinical hepatic encephalopathy. Arch. Neurol. 53:758–763.
Mesulam, M.M. (1981). A cortical network for directed attention and unilateral neglect. Ann. Neurol. 10:309–325.
Pardo, J.V., Pardo, P.J., Janer, K.W., and Raichle, M.E. (1990). The anterior cingulate cortex mediates processing selection in the Stroop attentional conflict paradigm. Proc. Natl. Acad. Sci. U.S.A. 87:256–259.
Posner, M.I., and Petersen, S.E. (1990). The attention system of the human brain. Annu. Rev. Neurosci. 13:25–42.
Rikkers, L., Jenko, P., Rudman, D., and Freides, D. (1978). Subclinical hepatic encephalopathy: Detection, prevalence, and relationship to nitrogen metabolism. Gastroenterology 75:462–469.
Schomerus, H., Hamster, W. (1998). Neuropsychological aspects of portal-systemic encephalopathy. Metab. Brain Dis. 13:361–377.
Schomerus, H., Hamster, W., Blunck, H., Reinhard, U., Mayer, K., and Dolle, W. (1981). Latent portasystemic encephalopathy. I. Nature of cerebral functional defects and their effect on fitness to drive. Dig. Dis. Sci. 26:622–630.
Shallice, T. (1988). From Neuropsychology to mental structure, Cambridge University Press, Cambridge.
Stuss, D.T., Floden, D., Alexander, M.P., Levine, B., and Katz, D. (2001). Stroop performance in focal lesion patients: Dissociation of processes and frontal lobe lesion location Neuropsychologia 39:771–786.
Tarter, R.E., Hegedus, A.M., Van Thiel, D.H., Schade, R.R., Gavaler, J.S., and Starzl, T.E. (1984). Nonalcoholic cirrhosis associated with neuropsychological dysfunction in the absence of overt evidence of hepatic encephalopathy. Gastroenterology 86:1421–1427.
Tarter, R.E., Panzak, G., Switala, J., Lu, S., Simkevitz, H., and Van Thiel, D. (1997). Isokinetic muscle strength and its association with neuropsychological capacity in cirrhotic alcoholics. Alcohol Clin. Exp. Res. 21:191–196.
Weissenborn, K., Scholz, M., Hinrichs, H., Wiltfang, J., Schmidt, F.W., Kunkel, H. (1990). Neurophysiological assessment of early encephalopathy. Electroencephalogr. Clin. Neurophysiol. 75:289–295.
Weissenborn, K., Heidenreich, S., Ennen, J., and Ruckert, N. (2001). Attention deficit in minimal hepatic encephalopathy. Metab. Brain Dis. 16:13–19.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Amodio, P., Schiff, S., Piccolo, F.D. et al. Attention Dysfunction in Cirrhotic Patients: An Inquiry on the Role of Executive Control, Attention Orienting and Focusing. Metab Brain Dis 20, 115–127 (2005). https://doi.org/10.1007/s11011-005-4149-3
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s11011-005-4149-3