Minimal hepatic encephalopathy refers to minimal to mild cognitive impairment that occurs in patients with liver disease. Although this may be difficult to define precisely, patients are at risk for progression to overt encephalopathy.
The main feature is mild cognitive impairment identified on neuropsychological testing, most often involving one or more of the following:
(1) impaired visuo-spatial functioning
(2) attention
(3) psychomotor speed and concentration
Patients do not have overt encephalopathy, yet the cognitive impairment may be sufficient to impact daily function.
Critical flicker frequency may be able to detect these patients. This technique measures the flashing light frequency at which the flashing light appears to be continuously on (termed the fusion frequency). As cognitive impairment increases the fusion frequency decreases.
Management may include:
(1) dietary protein restriction
(2) lactulose therapy
(3) attempts to reverse hepatic disease
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