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Minimal hepatic encephalopathy: A review

Raffaele Nardone1, Alexandra C Taylor2, Yvonne Höller2

  • 1Department of Neurology, Christian Doppler Klinik and Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria; Department of Neurology, Franz Tappeiner Hospital, Italy.

Neuroscience Research
|May 8, 2016
PubMed

Insights

Minimal hepatic encephalopathy (MHE) is early cognitive impairment in cirrhosis patients. Diagnosis uses neuroimaging, neurophysiology, and psychometric tests, impacting quality of life.

Area of Science:

  • Hepatology
  • Neurology
  • Psychiatry

Background:

  • Minimal hepatic encephalopathy (MHE) is the earliest stage of hepatic encephalopathy, affecting up to 80% of liver cirrhosis patients.
  • MHE presents with cognitive deficits in attention, vigilance, and executive function, yet lacks obvious clinical signs.
  • It significantly impacts daily life, quality of life, driving ability, and mortality.

Purpose of the Study:

  • To provide an updated review of minimal hepatic encephalopathy (MHE).
  • To cover epidemiology, burden, quality of life, diagnostic methods, and therapeutic strategies for MHE.

Main Methods:

  • Review of current literature on MHE.
  • Analysis of diagnostic tools including neuropsychological tests, psychometric tests (e.g., critical flicker frequency), and neurophysiological procedures (e.g., event-related potentials, EEG spectral analysis).
  • Inclusion of neuroimaging findings (MRI) and therapeutic approaches (e.g., ammonia-lowering agents, probiotics, rifaximin).

Main Results:

  • MHE is characterized by subtle cognitive impairments detectable by specialized tests.
  • EEG and MRI reveal early cerebral dysfunction and altered brain connectivity in MHE patients.
  • Current treatments focus on reducing ammonia, but liver transplantation may not fully reverse cognitive deficits.

Conclusions:

  • MHE is a prevalent and impactful condition in liver cirrhosis patients.
  • Early diagnosis and management are crucial for improving patient outcomes and quality of life.
  • Further research into effective therapies is warranted, as current treatments have limitations.
Keywords:
ElectroencephalographyEvent related potentialsHepatic encephalopathyMagnetic resonance imagingMinimal hepatic encephalopathyNeuropsychological testing

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