Cognition-tracking-based strategies for diagnosis and treatment of minimal hepatic encephalopathy

Abstract

Minimal hepatic encephalopathy (MHE), which shows mild cognitive impairment, is a subtle complication of cirrhosis that has been shown to affect daily functioning and quality of life. However, until 2014, relevant guidelines do not give much attention to the diagnosis and treatment of MHE, resulting in patients being ignored and denied the benefits of treatment. In this review, we summarize recent cognition-based research about (1) alteration of nerve cells, including astrocytes, microglial cells and neurons, in mild cognitive impairment in MHE; (2) comparison of methods in detecting cognitive impairment in MHE; and (3) comparison of methods for therapy of cognitive impairment in MHE. We hope to provide information about diagnosis and treatment of cognitive impairment in patients with MHE.

Prevalence and risk factors of covert hepatic encephalopathy in cirrhotic patients: A multicenter study in China

“…This might be due to the multiple mental function aspects of CHE which may or may not be impaired simultaneously at the same level, and to the greater or lesser suitability of each test for a particular abnormality of mental function. For example, the PHES is most reliable for measuring cognitive impairment, whereas the Stroop test is good at evaluating attention and concentration capacities, ICT focuses on assessing executive functions such as attention and response inhibition, the CFF test concentrates on visual discrimination, and RBANS is specialized in revealing deficits in verbal and visual anterograde memory, working memory, cognitive processing speed, language ability, and visuospatial ability 21,24–28 . Therefore, in 2022 the European Association for the Study of the Liver (EASL) guidelines stated that there was no gold standard for the diagnosis of CHE and that each test or tool had its advantages and disadvantages 1 .…”

Forgettable in the care of liver cirrhosis: the unseen culprits of progression from bad to worse

“…Early detection through screening tests is of critical importance because it enables timely initiation of treatment and prevents the progression of the disease to overt hepatic encephalopathy. It is worth noting that patients with MHE have been found to have a higher incidence of vehicle accidents [ 51 , 52 ].…”

Iatrogenic liver diseases: a new concept, with practices to be condemned

“…There are several screening tests available for MHE, including the psychometric hepatic encephalopathy score (PHES), inhibitory control test (ICT), critical icker frequency (CFF), and the Stroop test. These tests are non-invasive and can be easily performed in an outpatient setting (39).…”