ArticleClinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association2015
Validation of EncephalApp, Smartphone-Based Stroop Test, for the Diagnosis of Covert Hepatic Encephalopathy.
Article in Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 103 papers, 4 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The Influence of Shunting Left/Right Portal Vein Branch on Post-transjugular Intrahepatic Portosystemic Shunt Hepatic Encephalopathy: a Multicenter Randomized Controlled Trial
Effect of Supplemental Nightly Melatonin On REM and Cognition in Hepatic Encephalopathy (SNORE-HE) Trial
Who cites it
103 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension.Gut · 2020Guideline
- KASL clinical practice guidelines for liver cirrhosis: Varices, hepatic encephalopathy, and related complications.Clinical and molecular hepatology · 2020Guideline
- Chinese guidelines on management of hepatic encephalopathy in cirrhosis.World journal of gastroenterology · 2019Guideline
- Diagnosis of Minimal Hepatic Encephalopathy: A Systematic Review of Point-of-Care Diagnostic Tests.The American journal of gastroenterology · 2018Pooled it
- Clinical Trial: Lemborexant Efficacy and Safety in Liver Cirrhosis-Randomized, Double-Blind, Crossover Clinical Trial.Alimentary pharmacology & therapeutics · 2026Trial
- Rifaximin Improves Cognitive Performance and Reduces Cirrhosis-Related Adverse Events in Covert Hepatic Encephalopathy: A Randomized Controlled Trial.Alimentary pharmacology & therapeutics · 2026Trial
- Walking and Sitting Outdoors: Which Is Better for Cognitive Performance and Mental States?International journal of environmental research and public health · 2022Trial
- Covert hepatic encephalopathy as a multi-organ syndrome: the gut-liver-muscle-brain axis, diagnosis, treatment, and multidisciplinary care.Journal of gastroenterology · 2026Review
- Letter: Interpretation of Cognitive and Clinical Outcomes in the Randomised Trial of Rifaximin for Covert Hepatic Encephalopathy.Alimentary pharmacology & therapeutics · 2026Article
- Driving in hepatic encephalopathy.Internal medicine journal · 2026Review
- Minimal Hepatic Encephalopathy: A Narrative Review.Cureus · 2026Review
- Covert hepatic encephalopathy in cirrhosis: implications for early diagnosis and appropriate management.Clinical journal of gastroenterology · 2026Review
- Clinical and Demographic Determinants of Adherence to Digital Monitoring in Cirrhosis: A Prospective Cohort Analysis.Research square · 2026Article
- Implementing Technology in Neuropsychological Assessments: A Scoping Review.Journal of medical systems · 2026Article
- Article
- Usefulness of the Stroop test in predicting decompensation events in patients with cirrhosis: A prospective cohort study.Scientific reports · 2026Article
- Pain, uncertainty, and lack of clinical support drive emergency department utilization in cirrhosis: A qualitative study.Hepatology communications · 2026Article
- Visuo-Cognitive Executive Functions in Amblyopia and Strabismus: Associations With Function and Quality of Life.Investigative ophthalmology & visual science · 2025Article
- Optimization of outpatient care for patients with decompensated liver cirrhosis: a post-discharge nursing initiative improves quality of life.Hepatobiliary surgery and nutrition · 2025Article
- Minimal Hepatic Encephalopathy in Cirrhotic Patients: A New Simple and Fast Digital Screening Method.United European gastroenterology journal · 2025Article
43 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
17 authors.
Funding
Abstract
BACKGROUND &
aimsDetection of covert hepatic encephalopathy (CHE) is difficult, but point-of-care testing could increase rates of diagnosis. We aimed to validate the ability of the smartphone app EncephalApp, a streamlined version of Stroop App, to detect CHE. We evaluated face validity, test-retest reliability, and external validity.
methodsPatients with cirrhosis (n = 167; 38% with overt HE [OHE]; mean age, 55 years; mean Model for End-Stage Liver Disease score, 12) and controls (n = 114) were each given a paper and pencil cognitive battery (standard) along with EncephalApp. EncephalApp has Off and On states; results measured were OffTime, OnTime, OffTime+OnTime, and number of runs required to complete 5 off and on runs. Thirty-six patients with cirrhosis underwent driving simulation tests, and EncephalApp results were correlated with results. Test-retest reliability was analyzed in a subgroup of patients. The test was performed before and after transjugular intrahepatic portosystemic shunt placement, and before and after correction for hyponatremia, to determine external validity.
resultsAll patients with cirrhosis performed worse on paper and pencil and EncephalApp tests than controls. Patients with cirrhosis and OHE performed worse than those without OHE. Age-dependent EncephalApp cutoffs (younger or older than 45 years) were set. An OffTime+OnTime value of >190 seconds identified all patients with CHE with an area under the receiver operator characteristic value of 0.91; the area under the receiver operator characteristic value was 0.88 for diagnosis of CHE in those without OHE. EncephalApp times correlated with crashes and illegal turns in driving simulation tests. Test-retest reliability was high (intraclass coefficient, 0.83) among 30 patients retested 1-3 months apart. OffTime+OnTime increased significantly (206 vs 255 seconds, P = .007) among 10 patients retested 33 ± 7 days after transjugular intrahepatic portosystemic shunt placement. OffTime+OnTime decreased significantly (242 vs 225 seconds, P = .03) in 7 patients tested before and after correction for hyponatremia (126 ± 3 to 132 ± 4 meq/L, P = .01) 10 ± 5 days apart.
conclusionsA smartphone app called EncephalApp has good face validity, test-retest reliability, and external validity for the diagnosis of CHE.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.