{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T03:26:17Z","timestamp":1787282777527,"version":"build-2736575974"},"reference-count":26,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100012553","name":"Chang Gung Memorial Hospital","doi-asserted-by":"publisher","award":["CMRPG3P0761"],"award-info":[{"award-number":["CMRPG3P0761"]}],"id":[{"id":"10.13039\/100012553","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012553","name":"Chang Gung Memorial Hospital","doi-asserted-by":"publisher","award":["CMRPG3M1932"],"award-info":[{"award-number":["CMRPG3M1932"]}],"id":[{"id":"10.13039\/100012553","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Kaohsiung J of Med Scie"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Minimal hepatic encephalopathy (MHE) involves subtle cognitive dysfunction and systemic inflammation and is associated with an increased risk of overt hepatic encephalopathy. The Animal Naming Test (ANT\n                    <jats:sub>1<\/jats:sub>\n                    ) is a rapid semantic fluency tool for MHE assessment, but its performance across different primary spoken languages remains unclear. We conducted a prospective proof\u2010of\u2010concept study to evaluate the diagnostic performance of ANT\n                    <jats:sub>1<\/jats:sub>\n                    and serum interleukin\u20106 (IL\u20106) in Mandarin\u2010 and Taiwanese Hokkien\u2010speaking cirrhotic patients. A total of 65 cirrhotic patients and 34 healthy controls were enrolled. Patients completed ANT\n                    <jats:sub>1<\/jats:sub>\n                    , simplified ANT\n                    <jats:sub>1<\/jats:sub>\n                    (S\u2010ANT\n                    <jats:sub>1<\/jats:sub>\n                    ), and standard psychometric assessments. MHE was defined by abnormal PHES and\/or visually assessed EEG slowing. Diagnostic discrimination was evaluated using AUROC analyses stratified by primary spoken language. A post hoc exploratory Taiwanese\u2010calibrated S\u2010ANT\n                    <jats:sub>1<\/jats:sub>\n                    was also assessed in Taiwanese Hokkien\u2010speaking patients. Sixteen cirrhotic patients (24.6%) were diagnosed with MHE. Patients with MHE had lower ANT1 scores and higher serum IL\u20106 levels than those without MHE. In Mandarin\u2010speaking patients (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200944), ANT\n                    <jats:sub>1<\/jats:sub>\n                    demonstrated an AUROC of 0.760, while serum IL\u20106 showed an AUROC of 0.841. The composite model combining ANT\n                    <jats:sub>1<\/jats:sub>\n                    and serum IL\u20106 showed a numerically higher AUROC of 0.895, but this improvement was not statistically significant in pairwise DeLong comparisons. In Taiwanese Hokkien\u2010speaking patients (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200921), standard ANT\n                    <jats:sub>1<\/jats:sub>\n                    showed a lower AUROC of 0.679. The exploratory Taiwanese\u2010calibrated S\u2010ANT\n                    <jats:sub>1<\/jats:sub>\n                    showed a numerically higher AUROC of 0.776; however, this post hoc finding was based on a small subgroup with 7 MHE events and requires external validation. This study suggests that primary spoken language may be associated with ANT\n                    <jats:sub>1<\/jats:sub>\n                    performance in MHE assessments. Integrating ANT\n                    <jats:sub>1<\/jats:sub>\n                    with serum IL\u20106 showed numerically improved discrimination in Mandarin speakers, whereas exploratory demographic calibration of S\u2010ANT\n                    <jats:sub>1<\/jats:sub>\n                    showed a numerically higher AUROC in Taiwanese Hokkien speakers. These findings are exploratory and hypothesis\u2010generating, necessitating validation in larger independent cohorts before clinical implementation.\n                  <\/jats:p>","DOI":"10.1002\/kjm2.70271","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T03:19:50Z","timestamp":1787282390000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Proof\u2010of\u2010Concept Study of Language\u2010Stratified Assessment for Minimal Hepatic Encephalopathy: Integrating the Animal Naming Test and Serum\n                    <scp>IL\u20106<\/scp>"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8110-5909","authenticated-orcid":false,"given":"Hsin\u2010Che","family":"Lin","sequence":"first","affiliation":[{"name":"Division of Hepatology, Department of Gastroenterology and Hepatology, Linkou Medical Center Chang Gung Memorial Hospital  Taoyuan Taiwan"},{"name":"College of Medicine Chang Gung University  Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0903-0682","authenticated-orcid":false,"given":"Cheng Jen","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Hepatology, Department of Gastroenterology and Hepatology, Linkou Medical Center Chang Gung Memorial Hospital  Taoyuan Taiwan"},{"name":"College of Medicine Chang Gung University  Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5083-8851","authenticated-orcid":false,"given":"Tsung\u2010Han","family":"Wu","sequence":"additional","affiliation":[{"name":"College of Medicine Chang Gung University  Taoyuan Taiwan"},{"name":"Department of General Surgery Chang\u2010Gung Memorial Hospital, Linkou Medical Center  Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Po\u2010Wen","family":"Gu","sequence":"additional","affiliation":[{"name":"College of Medicine Chang Gung University  Taoyuan Taiwan"},{"name":"Department of Laboratory Medicine Taipei Chang Gung Memorial Hospital  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun\u2010Yi","family":"Tsai","sequence":"additional","affiliation":[{"name":"College of Medicine Chang Gung University  Taoyuan Taiwan"},{"name":"Department of General Surgery Chang\u2010Gung Memorial Hospital, Linkou Medical Center  Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wey\u2010Ran","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Hepatology, Department of Gastroenterology and Hepatology, Linkou Medical Center Chang Gung Memorial Hospital  Taoyuan Taiwan"},{"name":"College of Medicine Chang Gung University  Taoyuan Taiwan"},{"name":"Liver Research Center, Chang Gung Memorial Hospital  Linkou Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao\u2010Wei","family":"Hsu","sequence":"additional","affiliation":[{"name":"Division of Hepatology, Department of Gastroenterology and Hepatology, Linkou Medical Center Chang Gung Memorial Hospital  Taoyuan Taiwan"},{"name":"College of Medicine Chang Gung University  Taoyuan Taiwan"},{"name":"Liver Research Center, Chang Gung Memorial Hospital  Linkou Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3007-3190","authenticated-orcid":false,"given":"Chun\u2010Yen","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Hepatology, Department of Gastroenterology and Hepatology, Linkou Medical Center Chang Gung Memorial Hospital  Taoyuan Taiwan"},{"name":"College of Medicine Chang Gung University  Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7656-4695","authenticated-orcid":false,"given":"Rong\u2010Nan","family":"Chien","sequence":"additional","affiliation":[{"name":"Division of Hepatology, Department of Gastroenterology and Hepatology, Linkou Medical Center Chang Gung Memorial Hospital  Taoyuan Taiwan"},{"name":"College of Medicine Chang Gung University  Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1689-3221","authenticated-orcid":false,"given":"Chien\u2010Hao","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Hepatology, Department of Gastroenterology and Hepatology, Linkou Medical Center Chang Gung Memorial Hospital  Taoyuan Taiwan"},{"name":"College of Medicine Chang Gung University  Taoyuan Taiwan"},{"name":"Liver Research Center, Chang Gung Memorial Hospital  Linkou Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2395-7599","authenticated-orcid":false,"given":"Piero","family":"Amodio","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Padova  Padova Italy"},{"name":"Private Clinic \u201cParco dei Tigli\u201d  Teolo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"issue":"2","key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1002\/hep.27210","article-title":"Hepatic Encephalopathy in Chronic Liver Disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver","volume":"60","author":"Vilstrup H.","year":"2014","journal-title":"Hepatology"},{"issue":"2","key":"e_1_2_9_3_1","first-page":"151","article-title":"The Burden of Minimal Hepatic Encephalopathy: From Diagnosis to Therapeutic Strategies","volume":"31","author":"Ridola L.","year":"2018","journal-title":"Annals of Gastroenterology"},{"issue":"11","key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1016\/j.cgh.2012.05.026","article-title":"Covert Hepatic Encephalopathy: Not as Minimal as You Might Think","volume":"10","author":"Kappus M. R.","year":"2012","journal-title":"Clinical Gastroenterology and Hepatology"},{"issue":"9","key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"1646","DOI":"10.1038\/ajg.2011.157","article-title":"The Multi\u2010Dimensional Burden of Cirrhosis and Hepatic Encephalopathy on Patients and Caregivers","volume":"106","author":"Bajaj J. S.","year":"2011","journal-title":"American Journal of Gastroenterology"},{"issue":"4","key":"e_1_2_9_6_1","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1002\/hep.23128","article-title":"Minimal Hepatic Encephalopathy Is Associated With Motor Vehicle Crashes: The Reality Beyond the Driving Test","volume":"50","author":"Bajaj J. S.","year":"2009","journal-title":"Hepatology"},{"issue":"3","key":"e_1_2_9_7_1","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1002\/hep.21533","article-title":"Lactulose Improves Cognitive Functions and Health\u2010Related Quality of Life in Patients With Cirrhosis Who Have Minimal Hepatic Encephalopathy","volume":"45","author":"Prasad S.","year":"2007","journal-title":"Hepatology"},{"issue":"6","key":"e_1_2_9_8_1","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1002\/hep.510290619","article-title":"Clinical Features and Survivial of Cirrhotic Patients With Subclinical Cognitive Alterations Detected by the Number Connection Test and Computerized Psychometric Tests","volume":"29","author":"Amodio P.","year":"1999","journal-title":"Hepatology"},{"issue":"10","key":"e_1_2_9_9_1","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1111\/apt.15515","article-title":"Raised Serum Interleukin\u20106 Identifies Patients With Liver Cirrhosis at High Risk for Overt Hepatic Encephalopathy","volume":"50","author":"Labenz C.","year":"2019","journal-title":"Alimentary Pharmacology & Therapeutics"},{"issue":"3","key":"e_1_2_9_10_1","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1097\/MCG.0b013e31815e7f58","article-title":"IL\u20106 and IL\u201018 in Blood May Discriminate Cirrhotic Patients With and Without Minimal Hepatic Encephalopathy","volume":"43","author":"Montoliu C.","year":"2009","journal-title":"Journal of Clinical Gastroenterology"},{"issue":"5","key":"e_1_2_9_11_1","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1002\/hep4.1883","article-title":"Evaluation of IL\u20106 for Stepwise Diagnosis of Minimal Hepatic Encephalopathy in Patients With Liver Cirrhosis","volume":"6","author":"Gairing S. J.","year":"2022","journal-title":"Hepatology Communications"},{"issue":"1","key":"e_1_2_9_12_1","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1002\/hep.29146","article-title":"The Animal Naming Test: An Easy Tool for the Assessment of Hepatic Encephalopathy","volume":"66","author":"Campagna F.","year":"2017","journal-title":"Hepatology"},{"key":"e_1_2_9_13_1","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.ejim.2018.08.008","article-title":"Validation of the Simplified Animal Naming Test as Primary Screening Tool for the Diagnosis of Covert Hepatic Encephalopathy","volume":"60","author":"Labenz C.","year":"2019","journal-title":"European Journal of Internal Medicine"},{"issue":"2","key":"e_1_2_9_14_1","doi-asserted-by":"crossref","first-page":"116","DOI":"10.5114\/ceh.2019.95105","article-title":"Animal Naming Test \u2010 A Simple and Accurate Test for Diagnosis of Minimal Hepatic Encephalopathy and Prediction of Overt Hepatic Encephalopathy","volume":"6","author":"Agarwal A.","year":"2020","journal-title":"Clinical and Experimental Hepatology"},{"issue":"3","key":"e_1_2_9_15_1","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1016\/j.jhep.2022.06.001","article-title":"EASL Clinical Practice Guidelines on the Management of Hepatic Encephalopathy","volume":"77","author":"European Association for the Study of the L","year":"2022","journal-title":"Journal of Hepatology"},{"issue":"1","key":"e_1_2_9_16_1","doi-asserted-by":"crossref","DOI":"10.1080\/07853890.2023.2236013","article-title":"Animal Naming Test Is a Simple and Valid Tool for Detecting Covert Hepatic Encephalopathy and Predicting Outcomes in Chinese\u2010Speaking Regions: A Preliminary Study","volume":"55","author":"Huang C. H.","year":"2023","journal-title":"Annals of Medicine"},{"issue":"2","key":"e_1_2_9_17_1","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1093\/arclin\/acz060","article-title":"A Cross\u2010Linguistic Comparison of Category Verbal Fluency Test (ANIMALS): A Systematic Review","volume":"35","author":"Ardila A.","year":"2020","journal-title":"Archives of Clinical Neuropsychology"},{"issue":"5","key":"e_1_2_9_18_1","doi-asserted-by":"crossref","first-page":"1680","DOI":"10.1053\/j.gastro.2011.06.085","article-title":"Electroencephalography in Patients With Cirrhosis","volume":"141","author":"Marchetti P.","year":"2011","journal-title":"Gastroenterology"},{"issue":"6","key":"e_1_2_9_19_1","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1111\/j.1478-3231.2009.02030.x","article-title":"Neurophysiological Investigations of Hepatic Encephalopathy: ISHEN Practice Guidelines","volume":"29","author":"Guerit J. 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F.","year":"1975","journal-title":"Journal of Psychiatric Research"},{"issue":"5","key":"e_1_2_9_22_1","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1016\/S0168-8278(01)00026-5","article-title":"Neuropsychological Characterization of Hepatic Encephalopathy","volume":"34","author":"Weissenborn K.","year":"2001","journal-title":"Journal of Hepatology"},{"issue":"5","key":"e_1_2_9_23_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.clinre.2021.101729","article-title":"Animal Naming Test for the Assessment of Minimal Hepatic Encephalopathy in Asian Cirrhotic Populations","volume":"45","author":"Qu Y.","year":"2021","journal-title":"Clinics and Research in Hepatology and Gastroenterology"},{"issue":"6","key":"e_1_2_9_24_1","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1080\/02699200902839800","article-title":"Semantic Verbal Fluency in Two Contrasting Languages","volume":"23","author":"Pekkala S.","year":"2009","journal-title":"Clinical Linguistics & Phonetics"},{"issue":"10","key":"e_1_2_9_25_1","doi-asserted-by":"crossref","DOI":"10.3390\/bs10100155","article-title":"Lexical and Cognitive Underpinnings of Verbal Fluency: Evidence From Bengali\u2010English Bilingual Aphasia","volume":"10","author":"Patra A.","year":"2020","journal-title":"Behavioral Sciences (Basel)"},{"issue":"3","key":"e_1_2_9_26_1","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1080\/23273798.2014.918630","article-title":"Proficiency and Control in Verbal Fluency Performance Across the Lifespan for Monolinguals and Bilinguals","volume":"30","author":"Friesen D. C.","year":"2015","journal-title":"Language, Cognition and Neuroscience"},{"key":"e_1_2_9_27_1","first-page":"208","volume-title":"Measuring L2 Proficiency: Perspectives From SLA","author":"Gertken L. M. A. M.","year":"2014"}],"container-title":["The Kaohsiung Journal of Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/kjm2.70271","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/kjm2.70271","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/kjm2.70271","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T03:19:59Z","timestamp":1787282399000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/kjm2.70271"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,20]]},"references-count":26,"alternative-id":["10.1002\/kjm2.70271"],"URL":"https:\/\/doi.org\/10.1002\/kjm2.70271","archive":["Portico"],"relation":{},"ISSN":["1607-551X","2410-8650"],"issn-type":[{"value":"1607-551X","type":"print"},{"value":"2410-8650","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,20]]},"assertion":[{"value":"2026-02-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70271"}}