Determination of Turkish norms of psychometric tests for diagnosing minimal hepatic encephalopathy and proposal of a high sensitive screening test battery

BACKGROUND

Psychometric hepatic encephalopathy score (PHES) needs local standardization.

AIMS

This study aimed at standardizing PHES for Turkish patients and compare them with German norms; to determine minimal hepatic encephalopathy (mHE) prevalence with two different methods [PHES battery and Critical Flicker Frequency (CFF)] and to assess whether sub-tests of the battery can be used for screening for mHE.

METHODS

Healthy volunteers (n = 816; 400 male) and cirrhotics (n = 124; 58 male) were included. For mHE diagnosis PHES score threshold was set at ≤ - 5 points and that of CFF at < 39 Hz. For comparing German and Turkish norms, datasets were combined. Multiple backward procedure was applied to assess effects of age, sex and education on single tests of the battery. Receiver operating characteristic (ROC) curves were created for assessing diagnostic capabilities of subtests of the battery.

RESULTS

PHES norms for Turks were developed. MHE prevalence in compensated cirrhotics was 29.8% and 27.4% with PHES and CFF tests, respectively, with low compatibility (kappa coefficient 0.389); mHE prevalence decreased to 16% when both tests were combined. Turks performed worse vs Germans in the digit symbol (DS) and serial dotting (SD) subtests but performed better in other subtests. In ROC analyzes of subtests, the combination of DS + SD tests achieved an AUROC of 0.974 versus PHES.

CONCLUSIONS

Use of two methods for diagnosing mHE is important for research purposes. From a clinical perspective, sensitivity with acceptable specificity may suffice for screening instruments for mHE. Combined use of DS and SD subtests of the PHES battery appears suitable for this purpose.

Subjective age-of-acquisition norms for 600 Turkish words from four age groups

The main purpose of this study was to report age-based subjective age-of-acquisition (AoA) norms for 600 Turkish words. A total of 115 children, 100 young adults, 115 middle-aged adults, and 127 older adults provided AoA estimates for 600 words on a 7-point scale. The intraclass correlations suggested high reliability, and the AoA estimates were highly correlated across the four age groups. Children gave earlier AoA estimates than the three adult groups; this was true for high-frequency as well as low-frequency words. In addition to the means and standard deviations of the AoA estimates, we report word frequency, concreteness, and imageability ratings, as well as word length measures (numbers of syllables and letters), for the 600 words as supplemental materials. The present ratings represent a potentially useful database for researchers working on lexical processing as well as other aspects of cognitive processing, such as autobiographical memory.