Video games improved cognitive function of patients with covert hepatic encephalopathy

BOSTON — Cognitive rehabilitation using iPod video games was effective and improved overall cognitive performance in patients with covert hepatic encephalopathy, according to data presented at The Liver Meeting.

“Our study shows that brain training using nonpharmacological measures, such as iPod games, can be useful in improving overall brain function in patients with cirrhosis with cognitive dysfunction,” Jasmohan S. Bajaj, MD, from the division of gastroenterology, hepatology and nutrition, Virginia Commonwealth University and McGuire VA Medical Center, told Healio.com/Hepatology.

Jasmohan S. Bajaj

The study included 20 patients with covert hepatic encephalopathy (12 men; mean age, 56 years; MELD score, 10).

Patients attended four clinical visits during the 8-week study period. Various standard covert hepatic encephalopathy tests were performed at each visit. At the second visit, patients were given an iPod with two games — IQ Boost to measure working memory task levels and Arcade Challenge to measure psychomotor accuracy — and instructed to play the games for at least 30 minutes per day for 4 weeks. The iPod was returned at the third visit, when covert hepatic encephalopathy tests were administered again to measure the impact of the video games on cognitive performance. At the fourth visit, researchers gauged cognition without iPod use.

Between visits one and two, cognitive analyses showed improvement in the number connection tests A (39.6 vs. 32.7) and B (124 vs. 94.5); digit symbol test (53 vs. 60.1); and block design test (25.2 vs. 28). Inhibitory control test scores showed improvement only when the patients were playing the iPod video games, and returned to baseline scores when the games were returned at the third visit (lures: 7.8 at visit 1, 7.9 at visit 2, 6.1 at visit 3, 5.9 at visit 4; targets: 95.5 at visit 1, 97.2 at visit 2, 98.8 at visit 3, 95.4 at visit 4).

The researchers reported significant improvement in the Hopkins Verbal Learning Test unrelated to covert hepatic encephalopathy or iPod games on delayed recall, according to the abstract.

Twenty-seven percent of the patients’ cognitive performance changed from impaired to normal at the fourth visit after iPod use (P<.004). The researchers also observed a nonsignificant trend toward increased total recall after iPod use.

“We believe these findings are important because drug treatment for patients with covert hepatic encephalopathy is not currently standard of care,” Bajaj said in an interview. “Therefore, non-drug methods that improve cognitive performance are a viable alternative that may help improve patients’ overall daily function.” – by Melinda Stevens

For more information:

Bajaj JS. Poster 352. Presented at: The Liver Meeting; Nov. 7-11, 2014; Boston.

Disclosure: Bajaj reports serving on advisory committees or review panels for the American College of Gastroenterology, Grifols, Merz, Ocera, Otsuka and Salix, and grant/research support from Grifols, Otsuka and Salix.