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Diagnosis of Minimal Hepatic Encephalopathy

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Book cover Hepatic Encephalopathy

Part of the book series: Clinical Gastroenterology ((CG))

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Abstract

Minimal hepatic encephalopathy (MHE) is a neurocognitive disorder that can affect up to 80% of cirrhotic patients. Patients seem clinically unimpaired, but have subtle deficits and psychomotor abnormalities that can only be elicited by specialized tests. Used singly or in combination, varying tests can provide diagnostic information, including neuropsychological testing or neurophysiological testing. While there is no gold standard for the diagnosis, MHE remains an important entity for clinicians to recognize because of its negative impact on a patient’s health-related quality of life and association with driving impairment and vehicular accidents. The currently available tests are broadly divided into neuropsychological or neurophysiological. Prominent neuropsychological tests are the psychometric hepatic encephalopathy score, inhibitory control tests and repeatable battery for the assessment of neuropsychological status. Standard EEG and other variations thereof, critical flicker frequency as well as evoked potentials are the most studied neurophysiological tests. There is an immense variation in local norms for each test which makes standardization difficult. There is a clear need for the standardization of, and consensus on, employing these tools or developing a universally applicable tool in the evaluation and diagnosis of MHE.

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Author information

Authors and Affiliations

  1. Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, VA, 23298, USA

    Jennifer Y. Montgomery MD

  2. Department of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, 1201 Broad Rock Boulevard, Richmond, VA, 23249, USA

    Jasmohan S. Bajaj MBBS, MD, MS

Authors
  1. Jennifer Y. Montgomery MD
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  2. Jasmohan S. Bajaj MBBS, MD, MS
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Corresponding author

Correspondence to Jasmohan S. Bajaj MBBS, MD, MS .

Editor information

Editors and Affiliations

  1. , Division of Gastroenterology, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, 44145, USA

    Kevin D. Mullen

  2. , Division of Gastroenterology, MetroHealth Medical Center, 2500 MetroHealth Medical Center, Cleveland, 44145, USA

    Ravi K. Prakash

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Montgomery, J.Y., Bajaj, J.S. (2012). Diagnosis of Minimal Hepatic Encephalopathy. In: Mullen, K., Prakash, R. (eds) Hepatic Encephalopathy. Clinical Gastroenterology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-61779-836-8_8

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  • DOI: https://doi.org/10.1007/978-1-61779-836-8_8

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  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-61779-835-1

  • Online ISBN: 978-1-61779-836-8

  • eBook Packages: MedicineMedicine (R0)

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