Subclinical encephalopathy

Subclinical hepatic encephalopathy (SHE)--cognitive deficits in the absence of overt encephalopathy--is frequently present in patients with cirrhosis. In the absence of biological correlates, diagnosis of SHE relies on psychometric tests. Attentional and motor abnormalities are the most common neurocognitive deficits. Sleep disturbances--a frequent complaint in cirrhosis--may be part of the spectrum of SHE. The impact of SHE on daily activities is controversial as patients may adapt their lives to cognitive limitations. Demanding activities, such as driving motor vehicles, may be impaired, though a blanket restriction appears premature. The benefit of treating SHE is not established. Antiencephalopathic drugs may be effective and can be considered in certain individuals.