The Mind and Liver Test: A New Approach to the Diagnosis of Minimal Hepatic Encephalopathy in Resource-Poor Settings

Table 2

MALT instruction cum scoring sheet.

Sl	Method of administering the test	Instruction to fill up the next column	Step score	Final count
1	Copy the figures; The subject is asked to draw the shown geometrical figures (printed on the board) onto a provided ruled paper, without altering the size; (The original figures cross three units on the same paper)	Symmetrical figure…0; else…1; Number of units crossed	⋯; 3-…	⋯
2	Group similar objects; The subject is shown one card (of a set of cards) showing the pictures of a few things belonging to two different categories (birds and vegetables, say). The subject is asked to place the blocks of the same color on objects of the same type	Number of objects misgrouped	…/2	⋯
3	Trace the sequence; The subject is shown a card to trace a well known sequence (like seed-sapling-tree-wood log-table); The examiner waits for a maximum of 1 minute, else proceeds to the next step	Score the time in seconds; 0–10 s…0, 11–20 s…1, 21–30 s…2, 31–40 s…3, >40 s…4	⋯	⋯
4	Name the animals; A: the subject is shown an animal (a cow, say) and is asked to name it	Score time in seconds; <5 s…0, 5–15 s…1, >15 s…2	⋯	⋯
	B: the subject is asked to separate animals of a certain kind from among the toys	<15 s…0, else 1	⋯
5	Build the wall; The subject is asked to build a two layered wall on the given line using the provided blocks The examiner waits for a maximum of 1 minute and then proceeds to the next step	A well built wall…0; Asymmetrical…1; Unable to build…2; (Asymmetry is defined as inability to place the blocks linearly either along the line in the game board or inability to stack two layers one over the other)	⋯	⋯
	Instruction box; The subject is made to hear three different bell sounds like the alarm, ambulance, and church bell using the audio device. He is also asked to be vigilant about the things he sees in the rest of the game
6	Complete the task; The patient is asked to arrange in sequence, the cards depicting the steps of a daily act performed by people at home; The examiner waits for a maximum of 1 minute and then proceeds to the next step	Able to complete the task…0; Else…1	⋯	⋯
7	Remember the arrangement; The subject is shown an arrangement in the shelf (image available on a question card) and it is narrated once for convenience; Immediately following this, the subject is asked to recall the arrangement	Number of objects recalled correctly	(6-…)/2	⋯
8	Cut along the line; The subject is asked to cut along a line with both indentation and curve; The graph sheet on the reverse is analyzed for deviation	Deviation (in small units); 5–10…3; >10…5	⋯	⋯
		Time (in seconds); >45…5, else…0	⋯
9	Recall the steps of the game till this point, in no specific order	Number of steps recalled	8-…	⋯
	The examiner asks a question pertaining to the sequence of the steps (what comes after X, say)	Correct answer…0; Else…1	⋯
10	Identify the sound of the bell; One of the three bells sounded in the instruction box is sounded again	Unable to identify…1; Else…0	⋯	⋯
11	Trace the path; Subject is asked to trace a 5 mm thick path to the shop	Time (in seconds); >30 s…5, 16–30 s…3; Else…0	⋯	⋯
		Deviation (in small grids on the graph paper); <5…0, 5–15…3, 16–25…4, >25…5	⋯
12	What from the shop?; The subject is asked if he remembers what he had to get for the empty basket on the lowest shelf of the rack (This tests the recall of the question card shown in Step 7)	Incorrect…1; Else…0	⋯	⋯
13	How much to pay?; The subject is given a simple calculation pertaining to day to day transactions	Incorrect…1; Else…0	⋯	⋯
14	Choose the shortest path; The subject is asked to choose the shortest path back home	Incorrect…1; Else…0	⋯	⋯
15	Quiz; The subject is asked if he saw certain things on the game board while tracing the path to the shop	Number of questions answered	4-…	⋯
16	Time, space, and reason	A wrong answer to the question pertaining to spatial and temporal orientation, and silence in response to the reasoning question would be marked as “D” (for disoriented)