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Video game-based therapy does not improve HRQOL in hepatic encephalopathy

Video game training does not improve health-related quality of life among patients with cirrhosis and covert hepatic encephalopathy, according to new findings published in the American Journal of Gastroenterology.

“Brain training with video games in covert [hepatic encephalopathy] shows improvements in brain MRI, but this did not translate into improvements in quality of life or cognition,” Jasmohan S. Bajaj, MD, MSc, FACG, from the division of gastroenterology, hepatology and nutrition, Virginia Commonwealth University and McGuire VA Medical Center, told Healio.com/Hepatology.

Jasmohan S. Bajaj

Bajaj and colleagues evaluated 30 patients with covert hepatic encephalopathy (HE) administered 4 weeks of tracked video games accompanied by visits that tracked learning pre- and post-video game initiation. The trial included three phases over 8 weeks: learning phase, where cognitive tests were administered twice over 2 weeks without intervening intervention; training phase, where patients underwent daily video game training for 4 weeks; and post-training phase, which included testing 2 weeks after the video game training ended.

The goals of the study were to determine if cognitive rehabilitation using video games can improve neuropsychological performance in specific domains, evaluate any impact this rehabilitation may have on health-related quality of life (HRQOL) and measure the impact of this training on brain MRI.

All 30 patients completed all visits with “significant daily achievement on the video games,” the researchers wrote.  

Among 13 patients who underwent brain MRI, the researchers observed a significant decrease in fractional anisotropy and increased radial diffusivity across various brain regions, including corpus callosum, internal capsule and sections of the corticospinal tract. This increase suggested axonal sprouting or increased cross-fiber formation, according to the research. In addition, there was improvement in the visuospatial resting-state connectivity identical to the video game training domains.

There was no significant identical improvement in HRQOL or Hopkins verbal learning test performance noted, but cognitive performance did transiently improve on cognitive tests like the video games during training.

Although the video game rehabilitation did not improve HRQOL, it affected the resting state connectivity and diffusion tensor imaging findings. Bajaj and colleagues said that this type of rehabilitation may facilitate “functional and structural brain connectivity.”

“Further research into larger sample sizes may be needed or this could reflect that treatments that impact the gut, decrease inflammation or ammonia may be the treatments for covert HE rather than brain focused strategies,” Bajaj said. – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.