Despite the necessity to evaluate cognition in children with portal hypertension for minimal hepatic encephalopathy (MHE), few screening approaches are available. The Pediatric Perceived Cognitive Function (PedsPCF) item bank from the Patient-Reported Outcomes Measurement Information System (PROMIS), a 43-item parent- and self-report questionnaire, might be a valuable screening tool. The purpose of the study was to assess the PedsPCF item bank as a screening tool and investigate its relationship with other neurocognitive measures and clinical indications of portal hypertension.
Lurie Children’s Liver Clinic recruited pediatric patients with portal hypertension. A brief battery of neuropsychological tests focused on attention, executive functioning, and fine motor speed, as well as assessments of cognitive performance and quality of life, was delivered. There were a total of eighteen patients that took part in the study. The PedsPCF had a good correlation with the Behavior Rating Inventory of Execution Function (BRIEF) but not with neurocognitive testing. The PedsPCF is less sensitive than the BRIEF, according to qualitative heatmap analysis of the relationship between z-scores and clinical signs of portal hypertension. The fine motor task appears to have the highest sensitivity of the tests administered, while also being relatively quick and simple to administer.
In this little pilot sample, elements of the battery show promise. The BRIEF and the Grooved Pegboard may have the most clinical screening potential. More research is needed to investigate this topic in a larger multicenter sample.