What is the animal naming test?

Have you ever heard of the Animal Naming Test (ANT)? To me this appears like a game you’ll play with kids on the elementary school playground! I had never heard this term until I read the newest Clinical Practice Guidelines for the Management of Hepatic Encephalopathy (HE). The ANT is a fast, easy, and reliable verbal questionnaire used to guage for minimal or occult hepatic encephalopathy (MHE). It doesn’t require any special equipment and might be administered on an outpatient basis or on the bedside.

You may recall that HE is a neurological disorder attributable to liver dysfunction and characterised by changes in personality, consciousness, cognitive, and motor functions (Weissenborn, 2019). MHE is a gentle type of HE in patients with cirrhosis. MHE might be difficult to diagnose because routine physical examination may fail to detect abnormalities in mental status. The ANT assesses cognitive functions resembling verbal recall, information retrieval and self-control (i.e. keeping track of already given animal names), skills requiring intact memory, and executive functions.

How to do an animal naming test

Agarwal and colleagues (2020) describe ANT as follows:

• Ask the patient to say as many animal names as possible in a single minute.
• Record the patient’s reactions.
• If the patient stops before 1 minute, ask in the event that they would really like so as to add any more animals.
• If the patient doesn’t speak for 15 seconds, give him a cue. For example: “A tiger is an animal. Can you name any other animals?”
• After 1 minute, count all of the answers, apart from repeated words and words not related to animals.

In clinical studies, the ANT rating correlated with the psychometric hepatic encephalopathy rating (PHES), the currently advisable test for MHE, consisting of six tests that take roughly 10–quarter-hour to manage (Rodenbaugh et al., 2020; Agarwal et al., 2020) . However, PHES testing is time-consuming and sometimes impractical since the test have to be performed by a neuropsychologist (Rodenbaugh et al., 2020). ANT also correlated with the severity of liver disease assessed by the Model for End-Stage Liver Disease (MELD) and the Child-Turcotte-Pugh (CTP) rating (Agarwal et al., 2020).

Campagna and colleagues (2017) found that ANT is influenced by limited education (lower than 8 years) and advanced age (over 80 years). They developed a procedure for adjusting age and education and created a simplified ANT (S-ANT). Using S-ANT, the team divided the scoring into three levels:

• 0 = S-ANT greater than or equal to fifteen
• 1 = S-ANT between 10 and 15
• 2 = S-ANT lower than 10

The S-ANT tool might be utilized in clinical practice to detect MHE in patients with liver cirrhosis. A rating of 15 or higher correlates with normal cognitive function. A rating of 10 to fifteen indicates mild cognitive impairment requiring further evaluation. An S-ANT value of 10 or lower strongly indicates cognitive impairment and will be related to the event of overt HE in individuals with cirrhosis (Tapper et al., 2022).

The next time you encounter a patient with a history of cirrhosis and a traditional neurological examination, suggest or try an animal naming test. Let us know the way well it worked within the comments below.

Agarwal, A., Taneja, S., Chopra, M. Duseja, A., and Dhiman, R. K. (2020). Animal Naming Test – A straightforward and accurate test for diagnosing minimal hepatic encephalopathy and predicting overt hepatic encephalopathy. National Library of Medicine, National Institutes of Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7380476/

Campagna, F., Montagnese, S., Ridola, L., Senzolo, M., Schiff, S., De Rui, M., Pasquale, C., Nardelli, S., Pentassuglio, I., Merkel, C. , Angeli, P., Riggio, O., & Amodio, P. (2017). Animal naming test: a simple tool for assessing hepatic encephalopathy. , (1), 198–208. https://doi.org/10.1002/hep.29146

Labenz, C., Beul, L., Toenges, G., Schattenberg, J.M., Nagel, M., Sprinzl, M.F., Nguyen-Tat, M., Zimmermann, T., Huber, Y., Marquardt, J.U., Galle , P. R. and Wörns, M. A. (2019). Validation of the simplified animal naming test as a primary screening tool for the diagnosis of occult hepatic encephalopathy. , , 96–100. https://doi.org/10.1016/j.ejim.2018.08.008

Rodenbaugh, D., Vo, C. T., Redulla, R., and McCauley, K. (2020). Nursing management of hepatic encephalopathy. ,(2),E35–E47. https://doi.org/10.1097/SGA.0000000000000434

Tapper, E. B., Kenney, B., Nikirk, S., Levine, D. A., & Waljee, A. K. (2022). The animal naming test is related to poor patient-reported outcomes and frailty in individuals with and without cirrhosis: a prospective cohort study. , (1), e00447. https://doi.org/10.14309/ctg.0000000000000447

Weissenborn K. (2019). Hepatic encephalopathy: definition, clinical evaluation and diagnostic principles. , (Supplement 1), 5–9. https://doi.org/10.1007/s40265-018-1018-z