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Nicholas Cunniffe

Nicholas Cunniffe

University of Cambridge, United Kingdom

Title: Saccadometry: a novel diagnostic tool in Covert Hepatic Encephalopathy

Biography

Biography: Nicholas Cunniffe

Abstract

The study of saccadic latency, the variable time between presentation of a peripheral stimulus and foveation of the target, has provided important insights into the neural mechanisms underlying reaction times and decision. It has emerged as a powerful tool to quantify neurological impairment in a wide range of conditions. Patients with Huntington’s disease and Frontotemporaldementia, for example, generate saccades with significantly increased latency. In Parkinson’s disease meanwhile, saccadometrydemonstrates how neural function is affected by the disease and its treatment, for example deep brain stimulation. Our latest work has shown measurement of saccadic latency distributions in patients with liver cirrhosis can accurately detect Covert Hepatic Encephalopathy (CHE). This cognitive defect, found in 30-70% of cirrhosis patients, has been linked to poor quality of lifeand increased mortality, while early detection and appropriate treatment may reverse the deficit. Despite its clinical significance, diagnosis relies on psychometric tests that have proved unsuitable for clinical use. Our study diagnosed CHE in a subset among 36 cirrhosis patients by subjecting them to the World Congress of Gastroenterology standard of psychometric tests. We then used a portable saccadometer to measure their saccadic eye movements. We found those with CHE (16) had significantly prolonged saccadic latencies when compared with those without (20). There was in fact a spectrum of cognitive impairment among cirrhosis patients, with those defined as having CHE by psychometric testing having slower reaction times. Saccadometry therefore represents an opportunity for accurate and early diagnosis of CHE, better informing treatment in these patients.