Reviewer's report
Title:Mini-Mental State Examination in patients with hepatic encephalopathy and
liver cirrhosis. A prospective, quantified electroencephalography study.
Version: 1Date:8 April 2013
Reviewer: Michele Malaguarnera
Reviewer's report:
Major Compulsory Revision
1. The Mini Mental State Examination (MMSE) is a test that has not been used a
lot in cirrhotic patients and in hepatology in general. It is often used in the elderly
for screening and for its extreme simplicity in the evaluation of cognitive activities.
It is influenced by age and other factors. However, this test is lacking of
information on memory, orientation and spatial memory. In fact, for example
Malaguarnera et al. (2007) have used also other types of neuropsychological
tests such as: Trail making test, Wechsler Adult Intelligence Scale—Revised
(WAIS-R), Auditory Verbal Learning (AVL) (Malaguarnera M 2008), block design
test, and symbol digit modalities test, Logical Memory (Paragraph Recall),
Everyday Memory Questionnaire (EMQ) (Malaguarnera 2011) give more detailed
information. This should be challenged within the limits of the work.
2. ammonaemia is one of the parameters that affects hepatic encephalopathy
and cognitive activity in cirrhotic patients, why was not correlated with the
MMSE? This would be really important.
3. It is important a more careful classification of overt and covert hepatic
encephalopathy. Authors should decide whether to adopt the West-Haven
classification or to discriminate hepatic encephalopathy in overt and covert. I
advice you to to read those article if you did not:
1) Lauridsen MM, Thiele M, Kimer N, Vilstrup H. The continuous reaction times
method for diagnosing, grading, and monitoring minimal/covert hepatic
encephalopathy. Metab Brain Dis. 2013 Jan 10. [Epub ahead of print]
2) Kappus MR, Bajaj JS. Covert hepatic encephalopathy: not as minimal as you
might think. Clin Gastroenterol Hepatol. 2012 Nov;10(11):1208-19. doi:
10.1016/j.cgh.2012.05.026. Epub 2012 Jun 19.
3) Mullen KD, Prakash RK. Management of covert hepatic encephalopathy. Clin
Liver Dis. 2012 Feb;16(1):91-3. doi: 10.1016/j.cld.2011.12.006. Epub 2012 Jan
13.
Minor essential Revisions
3. Review misspellings (for example the title: “Discussion”)
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests
Reviewer's report
Title:Mini-Mental State Examination in patients with hepatic encephalopathy and
liver cirrhosis. A prospective, quantified electroencephalography study.
Version: 1Date:8 April 2013
Reviewer: Michele Malaguarnera
Reviewer's report:
Major Compulsory Revision
1. The Mini Mental State Examination (MMSE) is a test that has not been used a
lot in cirrhotic patients and in hepatology in general. It is often used in the elderly
for screening and for its extreme simplicity in the evaluation of cognitive activities.
It is influenced by age and other factors. However, this test is lacking of
information on memory, orientation and spatial memory. In fact, for example
Malaguarnera et al. (2007) have used also other types of neuropsychological
tests such as: Trail making test, Wechsler Adult Intelligence Scale—Revised
(WAIS-R), Auditory Verbal Learning (AVL) (Malaguarnera M 2008), block design
test, and symbol digit modalities test, Logical Memory (Paragraph Recall),
Everyday Memory Questionnaire (EMQ) (Malaguarnera 2011) give more detailed
information. This should be challenged within the limits of the work.
2. ammonaemia is one of the parameters that affects hepatic encephalopathy
and cognitive activity in cirrhotic patients, why was not correlated with the
MMSE? This would be really important.
3. It is important a more careful classification of overt and covert hepatic
encephalopathy. Authors should decide whether to adopt the West-Haven
classification or to discriminate hepatic encephalopathy in overt and covert. I
advice you to to read those article if you did not:
1) Lauridsen MM, Thiele M, Kimer N, Vilstrup H. The continuous reaction times
method for diagnosing, grading, and monitoring minimal/covert hepatic
encephalopathy. Metab Brain Dis. 2013 Jan 10. [Epub ahead of print]
2) Kappus MR, Bajaj JS. Covert hepatic encephalopathy: not as minimal as you
might think. Clin Gastroenterol Hepatol. 2012 Nov;10(11):1208-19. doi:
10.1016/j.cgh.2012.05.026. Epub 2012 Jun 19.
3) Mullen KD, Prakash RK. Management of covert hepatic encephalopathy. Clin
Liver Dis. 2012 Feb;16(1):91-3. doi: 10.1016/j.cld.2011.12.006. Epub 2012 Jan
13.
Minor essential Revisions
3. Review misspellings (for example the title: “Discussion”)
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests
Please review this paper.
user
Reviewer's report
Title:Mini-Mental State Examination in patients with hepatic encephalopathy and
liver cirrhosis. A prospective, quantified electroencephalography study.
Version: 1Date:8 April 2013
Reviewer: Michele Malaguarnera
Reviewer's report:
Major Compulsory Revision
1. The Mini Mental State Examination (MMSE) is a test that has not been used a
lot in cirrhotic patients and in hepatology in general. It is often used in the elderly
for screening and for its extreme simplicity in the evaluation of cognitive activities.
It is influenced by age and other factors. However, this test is lacking of
information on memory, orientation and spatial memory. In fact, for example
Malaguarnera et al. (2007) have used also other types of neuropsychological
tests such as: Trail making test, Wechsler Adult Intelligence Scale—Revised
(WAIS-R), Auditory Verbal Learning (AVL) (Malaguarnera M 2008), block design
test, and symbol digit modalities test, Logical Memory (Paragraph Recall),
Everyday Memory Questionnaire (EMQ) (Malaguarnera 2011) give more detailed
information. This should be challenged within the limits of the work.
2. ammonaemia is one of the parameters that affects hepatic encephalopathy
and cognitive activity in cirrhotic patients, why was not correlated with the
MMSE? This would be really important.
3. It is important a more careful classification of overt and covert hepatic
encephalopathy. Authors should decide whether to adopt the West-Haven
classification or to discriminate hepatic encephalopathy in overt and covert. I
advice you to to read those article if you did not:
1) Lauridsen MM, Thiele M, Kimer N, Vilstrup H. The continuous reaction times
method for diagnosing, grading, and monitoring minimal/covert hepatic
encephalopathy. Metab Brain Dis. 2013 Jan 10. [Epub ahead of print]
2) Kappus MR, Bajaj JS. Covert hepatic encephalopathy: not as minimal as you
might think. Clin Gastroenterol Hepatol. 2012 Nov;10(11):1208-19. doi:
10.1016/j.cgh.2012.05.026. Epub 2012 Jun 19.
3) Mullen KD, Prakash RK. Management of covert hepatic encephalopathy. Clin
Liver Dis. 2012 Feb;16(1):91-3. doi: 10.1016/j.cld.2011.12.006. Epub 2012 Jan
13.
Minor essential Revisions
3. Review misspellings (for example the title: “Discussion”)
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests
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