Psychomotor Speed and Frailty in Advanced Liver Disease: AJG | April 2026

Introduction

Minimal hepatic encephalopathy (MHE) and physical frailty are highly prevalent yet often under-recognised complications in patients with advanced chronic liver disease (AdvCLD). While MHE reflects subtle neurocognitive impairment, frailty represents systemic physical vulnerability. Traditionally, complex tools like the Psychometric Hepatic Encephalopathy Score have limited routine clinical assessment of MHE. The simpler Stroop EncephalApp (StE) offers a practical alternative, raising interest in understanding how cognitive dysfunction—particularly psychomotor speed—relates to physical frailty.

Problem Statement

Despite both MHE and frailty being strong predictors of poor outcomes, their interrelationship remains poorly defined. Specifically, it is unclear whether cognitive impairment assessed by simple tools like StE correlates meaningfully with frailty indices and whether this relationship can be used for risk stratification in clinical practice.

Summary

In this multicenter study of patients awaiting liver transplantation, MHE was present in 73% and frailty in 18%. Patients with MHE had significantly worse Liver Frailty Index (LFI) scores and were more frequently classified as prefrail or frail. A strong correlation was observed between psychomotor speed—particularly StE off-time—and frailty, with LFI independently predicting MHE (OR 2.41).

These findings highlight a critical brain–muscle axis in cirrhosis, where impaired psychomotor speed mirrors physical decline. The study supports the use of simple bedside tools like StE to identify high-risk patients and suggests that integrated cognitive and physical interventions may improve outcomes in advanced liver disease.