1. Neuropsychiatric performance in patients with cirrhosis: Who is “normal”? 
Sara Montagnese, Michele De Rui, Paolo Angeli, Piero Amodio 
Journal of Hepatology 
Volume 66, Issue 4, Pages (April 2017)
DOI: /j.jhep
Copyright © 2016 European Association for the Study of the Liver Terms and Conditions

2. Fig. 1
The three neuropsychiatric case histories and their evolutions over time and in response to different clinical events, both by comparison with one another and with reference to normative data. Row 1 indicates neuropsychiatric classification according to normative data: green, unimpaired; orange, minimal HE; red, overt HE. These are the rigid, threshold-based boundaries within which patients are classified, irrespective of their clinical history and medical situation. In the subsequent rows, neuropsychiatric performance of the three clinical cases is presented relative to their personal best performance and their behaviour over time (E1, 2, 3: evaluations 1, 2, 3; horizontal reading), taking into account comorbidity and cognitive reserve. Comorbidity is represented as an insurmountable wall that prevents further improvement in neuropsychiatric performance while cognitive reserve (i.e. a compensatory ability/space for manoeuvre that protects the patient from more severe neuropsychiatric impairment) is represented by the blue sky. The figure should be read both horizontally (green, orange and red) and vertically (red dotted lines). Case report 1, row 2: Post-TIPS and while complaining of symptoms which affected his working performance, this patient always exhibited a neuropsychiatric performance which would qualify him as unimpaired in relation to the norms (vertical reading), and which improved further after ammonia-lowering treatment. Thus, while being constantly unimpaired in relation to the norms, he oscillated between unimpaired and minimal HE in relation to his own, top personal baseline performance (horizontal reading). Case report 2, row 3: Retrospective analysis of the neuropsychiatric evolution of this patient suggests that, taking into account all the comorbidities, his post-admission and post-treatment performance is the best he can reach and it is not possible to ameliorate it because of a “wall of comorbidities”, which may also be responsible for rapid transition from unimpaired to overt HE, relative to his top personal baseline performance (horizontal reading; shorter left-right distance between unimpaired and overt HE compared to norms and to case report 1, above). Case report 3, row 4: This patient qualified as unimpaired prior to and as minimal after TIPS placement, when both he and his family reported minor slowing in mental and motor performance. On both occasions, comparisons with his estimated personal best coincided with reference and normative data (vertical and horizontal reading), suggesting that he represented reasonably well the average behaviour of healthy individuals of similar age and educational attainment.
Journal of Hepatology  , DOI: ( /j.jhep )
Copyright © 2016 European Association for the Study of the Liver Terms and Conditions

3. Fig. 2
Cumulative proportion HE-free survival. Cumulative proportion HE-free survival (Kaplan-Meier plot) over 12months follow-up in relation to the standard PHES abnormality threshold of −4 (left panel; based on normative population data; Cox-Mantel p=0.0254) and the best-performing threshold of −2 (right panel; based on calculated risk; Cox-Mantel p=0.0044).
Journal of Hepatology  , DOI: ( /j.jhep )
Copyright © 2016 European Association for the Study of the Liver Terms and Conditions