Skip to main content
SpringerLink
Log in

Hepatic Encephalopathy

  • Chapter
  • First Online:
Handbook on the Neuropsychology of Aging and Dementia

Part of the book series: Clinical Handbooks in Neuropsychology ((CHNEURO))

  • 5823 Accesses

Abstract

Hepatic encephalopathy (HE) is a metabolically-induced, usually reversible neuropsychiatric syndrome that results in significant morbidity and mortality. The incidence is unknown, but it is estimated that most individuals with cirrhosis develop some degree of HE, and advanced age is a risk factor. Cognitive, behavioral, and motor dysfunction are the characteristic features, although the pattern and severity differ among grades. Neuropsychologists are most likely to encounter HE in the context of liver transplant evaluations. The current chapter reviews the classification and pathogenesis of HE, diagnosis and treatment considerations, and also provides a clinical case example and reviews practical issues that will arise for neuropsychologists involved in the care of patietns with HE.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 269.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 349.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 499.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Leevy C, Phillips J. Hospitalizations during the use of rifaximin versus lactulose for the treatment of hepatic encephalopathy. Dig Dis Sci. 2007;52:737–41.

    PubMed  Google Scholar 

  2. Poordad FF. Review article: the burden of hepatic encephalopathy. Aliment Pharmacol Ther. 2007;25(S1):3–9.

    PubMed  Google Scholar 

  3. Stewart C, Malinchoc M, Kim W, Kamath PS. Hepatic encephalopathy as a predictor of survival in patients with end stage liver disease. Liver Transpl. 2007;13:1366–71.

    PubMed  Google Scholar 

  4. Bustamante J, Rimola A, Ventura PJ, Navasa M, Ciera I, Reggiardo V, et al. Prognostic significance of hepatic encephalopathy in patients with cirrhosis. J Hepatol. 1999;30:890–5.

    PubMed  Google Scholar 

  5. Bernuau J, Durand F. Early prediction of encephalopathy in hospitalized patients with severe acute liver disease: the narrow window of opportunity for transplant-free survival. J Hepatol. 2009;51:977–80.

    PubMed  Google Scholar 

  6. Bernal W, Auzinger G, Dhawan A, Wendon J. Acute liver failure. Lancet. 2010;376:190–201.

    PubMed  Google Scholar 

  7. Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT. Hepatic encephalopathy—definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 2002;35:716–21.

    PubMed  Google Scholar 

  8. Schomerus H, Hamster W, Blunck H, Reinhard U, Mayer K, Dolle W. Latent portasystemic encephalopathy. I. Nature of cerebral functional defects and their effect on fitness to drive. Dig Dis Sci. 1981;26:622–30.

    PubMed  Google Scholar 

  9. Watanabe A, Tuchida T, Yata Y, Kuwabara Y. Evaluation of neuropsychological function in patients with liver cirrhosis with special reference to their driving ability. Metab Brain Dis. 1995;10:239–48.

    PubMed  Google Scholar 

  10. Wein C, Koch H, Popp B, Oehler G, Schauder P. Minimal hepatic encephalopathy impairs fitness to drive. Hepatology. 2004;39:739–45.

    PubMed  Google Scholar 

  11. Bajaj JS, Hafeezullah M, Hoffmann RG, Saeian K. Minimal hepatic encephalopathy: a vehicle for accidents and traffic violations. Am J Gastroenterol. 2007;102:1903–9.

    PubMed  Google Scholar 

  12. Bajaj JS, Hafeezullah M, Hoffmann RG, Varma RR, Franco J, Binion DG, et al. Navigation skill impairment: dimension of the driving difficulties in minimal hepatic encephalopathy. Hepatology. 2008;47:596–604.

    PubMed  Google Scholar 

  13. Bajaj JS, Saeian K, Schubert CM, Hafeezullah M, Franco J, Varma RR, et al. Minimal hepatic encephalopathy is associated with motor vehicle crashes: the reality beyond the driving test. Hepatology. 2009;50:1175–83.

    PubMed  Google Scholar 

  14. Groeneweg M, Quero JC, De Bruijn I, Hartmann IJ, Essink-bot ML, Hop WC, et al. Subclinical hepatic encephalopathy impairs daily functioning. Hepatology. 1998;28:45–9.

    PubMed  Google Scholar 

  15. Schomerus H, Hamster W. Quality of life in cirrhotics with minimal hepatic encephalopathy. Metab Brain Dis. 2001;16:37–41.

    PubMed  Google Scholar 

  16. Arguedas MR, DeLawrence TG, McGuire BM. Influence of hepatic encephalopathy on health-related quality of life in patients with cirrhosis. Dig Dis Sci. 2003;48:1622–6.

    PubMed  Google Scholar 

  17. Prasad S, Dhiman RK, Duseja A, Chawla YK, Sharma A, Agarwal R. Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy. Hepatology. 2007;45:549–59.

    PubMed  Google Scholar 

  18. Amodio P, Del Piccolo F, Marchetti P, Angeli P, Iemmolo R, Caregaro L, et al. Clinical features and survival of cirrhotic patients with subclinical cognitive alterations detected by the number connection test and computerized psychometric tests. Hepatology. 1999;29:1662–7.

    PubMed  Google Scholar 

  19. Amodio P, Del Piccolo F, Petteno E, Mapelli D, Angeli P, Iemmolo R, et al. Prevalence and prognostic value of quantified electroencephalogram (EEG) alterations in cirrhotic patients. J Hepatol. 2001;35:37–45.

    PubMed  Google Scholar 

  20. Das A, Dhiman RK, Saraswat VA, Verma M, Naik SR. Prevalence and natural history of subclinical hepatic encephalopathy in cirrhosis. J Gastroenterol Hepatol. 2001;16:531–5.

    PubMed  Google Scholar 

  21. Romero-Gomez M, Boza F, Garcia-Valdecasas MS, García E, Aguilar-Reina J. Subclinical hepatic encephalopathy predicts the development of overt hepatic encephalopathy. Am J Gastroenterol. 2001;96:2718–23.

    PubMed  Google Scholar 

  22. Saxena N, Bhatia M, Joshi YK, Garg PK, Tandon RK. Auditory P300 event-related potentials and number connection test for evaluation of subclinical hepatic encephalopathy in patients with cirrhosis of the liver: a follow-up study. J Gastroenterol Hepatol. 2001;16:322–7.

    PubMed  Google Scholar 

  23. Saxena N, Bhatia M, Joshi YK, Garg PK, Dwivedi SN, Tandon RK. Electrophysiological and neuropsychological tests for the diagnosis of subclinical hepatic encephalopathy and prediction of overt encephalopathy. Liver. 2002;22:190–7.

    PubMed  Google Scholar 

  24. Conn HO, Leevy CM, Vlahcevic ZR, Rodgers JB, Maddrey WC, Seeff L, et al. Comparison of lactulose and neomycin in the treatment of chronic portal-systemic encephalopathy. Gastroenterology. 1977;72:573–83.

    PubMed  Google Scholar 

  25. Atterbury CE, Maddrey WC, Conn HO. Neomycin-sorbitol and lactulose in the treatment of acute portal-systemic encephalopathy. A controlled, double-blind clinical trial. Am J Dig Dis. 1978;23:398–406.

    PubMed  Google Scholar 

  26. Citro V, Milan G, Tripodi FS, Gennari A, Sorrentino P, Gallotta G, et al. Mental status impairment in patients with West Haven grade zero hepatic encephalopathy: the role of HCV infection. J Gastroenterol. 2007;42:79–82.

    PubMed  Google Scholar 

  27. Dhiman RK, Saraswat VA, Sharma BK, Sarin SK, Chawla YK, Butterworth R, et al. Minimal hepatic encephalopathy: consensus statement of a working party of the Indian Association for Study of the Liver. J Gastroenterol Hepatol. 2010;25:1029–41.

    PubMed  Google Scholar 

  28. Riggio O, Angeloni S, Salvatori FM, De Santis A, Cerini F. Incidence, natural history, and risk factors of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt with polytetrafluoroethylene-covered stent grafts. Am J Gastroenterol. 2008;103:2738–46.

    PubMed  Google Scholar 

  29. D’Amico G, Morabito A, Pagliaro L, Marubini E. Survival and prognostic indicators in compensated and decompensated cirrhosis. Dig Dis Sci. 1986;31:468–75.

    PubMed  Google Scholar 

  30. Ginés P, Quintero E, Arroyo V, Teres J, Bruguera M, Rimola A, et al. Compensated cirrhosis: natural history and prognostic factors. Hepatology. 1987;7:122–8.

    PubMed  Google Scholar 

  31. O’Grady JG, Schalm SW, Williams R. Acute liver failure: redefining the syndromes. Lancet. 1993;342:273–5.

    PubMed  Google Scholar 

  32. Kim WR, Brown RS, Terrault NA, El-Serag H. Burden of liver disease in the United State: Summary of a workshop. Hepatology. 2002;36:227–42.

    Google Scholar 

  33. Cash WJ, McConville P, McDermott E, McCormick PA, Callender ME, McDougall NI. Current concepts in the assessment and treatment of hepatic encephalopathy. Q J Med. 2010;103:9–16.

    Google Scholar 

  34. Bajaj JS. Review article: the modern management of hepatic encephalopathy. Aliment Pharmacol Ther. 2010;31:537–47.

    PubMed  Google Scholar 

  35. Butterworth RF. Effects of hyperammonaemia on brain function. J Inherit Metab Dis. 1998;21(S1):6–20.

    PubMed  Google Scholar 

  36. Shawcross DL, Jalan R. The pathophysiologic basis of hepatic encephalopathy: central role for ammonia and inflammation. Cell Mol Life Sci. 2005;62:2295–304.

    PubMed  Google Scholar 

  37. Cordoba J, Minguez B. Hepatic encephalopathy. Semin Liver Dis. 2008;28:70–80.

    PubMed  Google Scholar 

  38. Bjerring PN, Eefsen M, Hansen BA, Larsen FS. The brain in acute liver failure. A tortuous path from hyperammonemia to cerebral edema. Metab Brain Dis. 2009;24:5–14.

    PubMed  Google Scholar 

  39. Barbaro G, Di Lorenzo G, Soldinui N, Giancaspro G, Bellomo G, Belloni G, et al. Flumazenil for hepatic encephalopathy grade III and IVa in patients with cirrhosis: an Italian multicentre double-blind, placebo-controlled, cross-over study. Hepatology. 1998;28:374–8.

    PubMed  Google Scholar 

  40. Haussinger D, Schliess F. Pathogenetic mechanisms of hepatic encephalopathy. Gut. 2008;57:1156–65.

    PubMed  Google Scholar 

  41. Butterworth RF. Thiamine deficiency-related brain dysfunction in chronic liver failure. Metab Brain Dis. 2009;24:189–96.

    PubMed  Google Scholar 

  42. Seyan AS, Hughes RD, Shawcross DL. Changing face of hepatic encephalopathy: role of inflammation and oxidative stress. World J Gastroenterol. 2010;16:3347–57.

    PubMed  Google Scholar 

  43. Master S, Gottstein J, Blei AT. Cerebral blood flow and the development of ammonia-induced brain edema in rats after portacaval anastomosis. Hepatology. 1999;30:876–80.

    PubMed  Google Scholar 

  44. Kosenko E, Venediktova N, Kaminsky Y, Montoliu C, Felipo V. Sources of oxygen radicals in brain in acute ammonia intoxication in vivo. Brain Res. 2003;981:193–200.

    PubMed  Google Scholar 

  45. Norenberg MD. Oxidative and nitrosative stress in ammonia neurotoxicity. Hepatology. 2003;37:245–8.

    PubMed  Google Scholar 

  46. Rama Rao KV, Jayakumar AR, Norenberg MD. Role of oxidative stress in the ammonia-induced mitochondrial permeability transition in cultured astrocytes. Neurochem Int. 2005;47:31–8.

    PubMed  Google Scholar 

  47. Albrecht J, Norenberg MD. Glutamine: a Trojan horse in ammonia neurotoxicity. Hepatology. 2006;44: 788–94.

    PubMed  Google Scholar 

  48. Bjerring PN, Hauerberg J, Frederiksen HJ, Jorgensen L, Hansen BA, Tofteng F, et al. Cerebral glutamine concentration and lactate-pyruvate ratio in patients with acute liver failure. Neurocrit Care. 2008;9:3–7.

    PubMed  Google Scholar 

  49. Butterworth RF. Hepatic encephalopathy: a neuropsychiatric disorder involving multiple neurotransmitter systems. Curr Opin Neurol. 2000;13:721–7.

    PubMed  Google Scholar 

  50. Lozeva V, Montgomery JA, Tuomisto L, Rocheleau B, Pannunzio M, Huet PM, et al. Increased brain serotonin turnover correlates with the degree of shunting and hyperammonemia in rats following variable portal vein stenosis. J Hepatol. 2004;40:742–8.

    PubMed  Google Scholar 

  51. Lozeva-Thomas V. Serotonin brain circuits with a focus on hepatic encephalopathy. Metab Brain Dis. 2004;19:413–20.

    PubMed  Google Scholar 

  52. Pidoplichko VI, Dani JA. Acid-sensitive ionic channels in midbrain dopamine neurons are sensitive to ammonium, which may contribute to hyperammonemia damage. Proc Natl Acad Sci USA. 2006;103:11376–80.

    PubMed  Google Scholar 

  53. Albrecht J, Bender AS, Norenberg MD. Potassium-stimulated GABA release is a chloride-dependent but sodium- and calcium-independent process in cultured astrocytes. Acta Neurobiol Exp (Wars). 1998;58:169–75.

    Google Scholar 

  54. Ahboucha S, Butterworth RF. Pathophysiology of hepatic encephalopathy: a new look at GABA from the molecular standpoint. Metab Brain Dis. 2004;19:331–43.

    PubMed  Google Scholar 

  55. Odeh M. Pathogenesis of hepatic encephalopathy: the tumor necrosis factor-α theory. Eur J Clin Invest. 2007;37:291–304.

    PubMed  Google Scholar 

  56. Rolando N, Wade J, Davalos M, Wendon J, Philpott-Howard J, Williams R. The systemic inflammatory response syndrome in acute liver failure. Hepatology. 2000;32:734–9.

    PubMed  Google Scholar 

  57. Vaquero J, Polson J, Chung C, Helenowski I, Schiodt FV, Reisch J, et al. Infection and the progression of hepatic encephalopathy in acute liver failure. Gastroenterology. 2003;125:755–64.

    PubMed  Google Scholar 

  58. Haussinger D, Schliess F. Astrocyte swelling and protein tyrosine nitration in hepatic encephalopathy. Neurochem Int. 2005;47:64–70.

    PubMed  Google Scholar 

  59. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4 (text revision)th ed. Washington, DC: American Psychiatric Association; 2000.

    Google Scholar 

  60. Munoz SJ. Hepatic encephalopathy. Med Clin North Am. 2008;92:795–812.

    PubMed  Google Scholar 

  61. Wehbe E, Saad D, Delgado F, Ta H, Antoun SA. Reversible hepatic decerebration: a case report and review of the literature. Eur J Gastroenterol Hepatol. 2010;22:759–60.

    PubMed  Google Scholar 

  62. Mukherjee KK, Chhabra R, Khosla VK. Raised intracranial pressure in hepatic encephalopathy. Indian J Gastroenterol. 2003;22(S2):62–565.

    Google Scholar 

  63. Hassanein T, Blei AT, Perry W, Hilsabeck R, Stange J, Larsen FS, et al. Performance of the Hepatic Encephalopathy Scoring Algorithm in a clinical trial of patients with cirrhosis and severe hepatic encephalopathy. Am J Gastroenterol. 2009;104:1392–400.

    PubMed  Google Scholar 

  64. Hassanein TI, Hilsabeck RC, Perry W. Introduction to the Hepatic Encephalopathy Scoring Algorithm (HESA). Dig Dis Sci. 2008;53:529–38.

    PubMed  Google Scholar 

  65. Jover R, Company L, Gutierrez A, Zapater P, Perez-Serra J, Girona E, et al. Minimal hepatic encephalopathy and extrapyramidal signs in patients with cirrhosis. Am J Gastroenterol. 2003;98:1599–604.

    PubMed  Google Scholar 

  66. McCrea M, Cordoba J, Vessey G, Blei AT, Randolph C. Neuropsychological characterization and detection of subclinical hepatic encephalopathy. Arch Neurol. 1996;53:758–63.

    PubMed  Google Scholar 

  67. Weissenborn K, Ennen JC, Schomerus H, Ruckert N, Hecker H. Neuropsychological characterization of hepatic encephalopathy. J Hepatol. 2001;34:768–73.

    PubMed  Google Scholar 

  68. Mooney S, Hassanein TI, Hilsabeck RC, Ziegler EA, Carlson MD, Maron LM, et al. Utility of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in patients with end stage liver disease awaiting liver transplant. Arch Clin Neuropsychol. 2007;22:175–86.

    PubMed  Google Scholar 

  69. Weissenborn K, Heidenreich S, Giewekemeyer K, Ruckert N, Hecker H. Memory function in early hepatic encephalopathy. J Hepatol. 2003;39:320–5.

    PubMed  Google Scholar 

  70. Ortiz M, Cordoba J, Jacas C, Flavia M, Esteban R, Guardia J. Neuropsychological abnormalities in cirrhosis include learning impairment. J Hepatol. 2006;44:104–10.

    PubMed  Google Scholar 

  71. Cadranel JF, Lebietz E, De Martino V, Bernard B, El Koury S, Tourbah A, et al. Focal neurological signs in hepatic encephalopathy in cirrhotic patients: underestimated entity? Am J Gastroenterol. 2001;96:515–8.

    PubMed  Google Scholar 

  72. Morgan MY, Blei A, Grungreiff K, Jalan R, Kircheis G, Marchesini G, et al. The treatment of hepatic encephalopathy. Metab Brain Dis. 2007;22:389–405.

    PubMed  Google Scholar 

  73. Phongsamran PV, Kim JM, Abbott JC, Rosenblatt A. Pharmacotherapy for hepatic encephalopathy. Drugs. 2010;70:1131–48.

    PubMed  Google Scholar 

  74. Als-Nielsen B, Gluud LL, Gluud C. Non-absorbable disaccharides for hepatic encephalopathy: systematic review of randomised trials. Br Med J. 2004;328:1046.

    Google Scholar 

  75. Mullen KD, Amodio P, Morgan MY. Therapeutic studies in hepatic encephalopathy. Metab Brain Dis. 2007;22:407–23.

    PubMed  Google Scholar 

  76. Neff GW, Kemmer N, Zacharias V, Kaiser T, Duncan C, McHenry R, et al. Analysis of hospitalizations comparing rifaximin versus lactulose in the management of hepatic encephalopathy. Transplant Proc. 2006;38:3552–5.

    PubMed  Google Scholar 

  77. Huang E, Esrailian E, Spiegel BMR. The cost effectiveness and budget impact of competing therapies in hepatic encephalopathy—a decision analysis. Aliment Pharmacol Ther. 2007;26:1147–61.

    PubMed  Google Scholar 

  78. Maclayton DO, Eaton-Maxwell A. Rifaximin for treatment of hepatic encephalopathy. Gastroenterology. 2009;43:77–84.

    Google Scholar 

  79. Bajaj JS, Schubert CM, Heuman DM, Wade JB, Gibson DP, Topaz A, et al. Persistence of cognitive impairment after resolution of overt hepatic encephalopathy. Gastroenterology. 2010;138:2332–40.

    PubMed  Google Scholar 

  80. Kondrup J, Muller MJ. Energy and protein requirements of patients with chronic liver disease. J Hepatol. 1997;27:239–47.

    PubMed  Google Scholar 

  81. Merli M, Riggio O. Dietary and nutritional indications in hepatic encephalopathy. Metab Brain Dis. 2009;24:211–21.

    PubMed  Google Scholar 

  82. Egberts EH, Schomerus H, Hamster W, Jurgens P. Branched chain amino acids in the treatment of latent portosystemic encephalopathy. A double-blind placebo-controlled cross-over study. Gastroenterology. 1985;88:887–95.

    PubMed  Google Scholar 

  83. Plauth M, Egberts EH, Hamster W. Long-term treatment of latent portosystemic encephalopathy with branched-chain amino acids: a double-blind placebo-controlled crossover study. J Hepatol. 1993;17:308–14.

    PubMed  Google Scholar 

  84. Marchesini G, Dioguardi FS, Bianchi GP. The Italian multicenter study group. Long-term oral branched-chain amino acids in advanced cirrhosis: a doubleblind casein-controlled trial. J Hepatol. 1990;11:92–101.

    PubMed  Google Scholar 

  85. Muto Y, Sato S, Watanabe A. Effects of oral branched-chain amino acid granules on event-free survival in patients with liver cirrhosis. Clin Gastroenterol Hepatol. 2005;3:705–13.

    PubMed  Google Scholar 

  86. Schulz GJ, Campos ACL, Coelho JCU. The role of nutrition in hepatic encephalopathy. Curr Opin Clin Nutr Metab Care. 2008;11:275–80; Carithers R. Liver transplantation. American Association for the Study of Liver Diseases. Liver Transpl. 2000; 6:122–35.

    Google Scholar 

  87. Cordoba J, Minguez B. Hepatic Encephalopathy. Sem Liver Dis. 2008;28:70–80.

    PubMed  Google Scholar 

  88. Stange J, Mitzner SR, Klammt S, et al. Liver support by extracorporeal blood purification: a clinical observation. Liver Transpl. 2000;6:603–13.

    PubMed  Google Scholar 

  89. Stadlbauer V, Wright AK, Jalan R. Role of artificial liver support in hepatic encephalopathy. Metab Brain Dis. 2009;24:15–26.

    PubMed  Google Scholar 

  90. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2:81–4.

    PubMed  Google Scholar 

  91. Ortiz M, Cordoba J, Dovals E, Jacas D, Pujadas F, Esteban R, et al. Development of a clinical hepatic encephalopathy staging scale. Aliment Pharmacol Ther. 2007;26:859–67.

    PubMed  Google Scholar 

  92. Bass NM. Review article: the current pharmacological therapies for hepatic encephalopathy. Aliment Pharmacol Ther. 2007;25(S1):23–31.

    PubMed  Google Scholar 

  93. Sotil EU, Gottstein J, Ayala E, Randolph C, Blei AT. Impact of preoperative overt hepatic encephalopathy on neurocognitive function after liver transplantation. Liver Transpl. 2009;15:184–92.

    PubMed  Google Scholar 

  94. Eroglu Y, Byrne WJ. Hepatic encephalopathy. Emerg Med Clin North Am. 2009;27:401–14.

    PubMed  Google Scholar 

  95. Mullen K. Review of the final report of the 1998 Working Party on definition, nomenclature and diagnosis of hepatic encephalopathy. Aliment Pharmacol Ther. 2007;25(S1):11–6.

    PubMed  Google Scholar 

  96. Jalan R. Pathophysiological basis of therapy of raised intracranial pressure in acute liver failure. Neurochem Int. 2005;47:78–83.

    PubMed  Google Scholar 

  97. Rovira A, Alonso J, Cordoba J. MR Imaging findings in hepatic encephalopathy. Am J Neuroradiol. 2008;29:1612–21.

    PubMed  Google Scholar 

  98. Cordoba J, Alonso J, Rovira A, Jacas C, Sanpedro F, Castells L, et al. The development of low-grade cerebral edema in cirrhosis is supported by the evolution of 1 H-magnetic resonance abnormalities after liver transplantation. J Hepatol. 2001;35:598–604.

    PubMed  Google Scholar 

  99. Rovira A, Cordoba J, Sanpedro F, Grive E, Rovira-Gols A, Alonso J. Normalization of T2 signal abnormalities in hemispheric white matter with liver transplant. Neurology. 2002;59:335–41.

    PubMed  Google Scholar 

  100. Cordoba J, Raguer N, Flavia M, Vargas V, Jacas C, Alonso J, et al. T2 hyperintensity along the cortico-spinal tract in cirrhosis relates to functional abnormalities. Hepatology. 2003;38:1026–33.

    PubMed  Google Scholar 

  101. Foley JM, Watson CW, Adams RD. Significance of the electroencephalographic changes in hepatic coma. Trans Am Neurol Assoc. 1950;75:161–5.

    Google Scholar 

  102. Guerit JM, Amantini A, Amodio P, Andersen KV, Butler S, de Weerd A, et al. Consensus on the use of neurophysiological tests in the intensive care unit (ICU): electroencephalogram (EEG), evoked potentials (EP), and electroneuromyography (ENMG). Clin Neurophysiol. 2009;39:71–83.

    Google Scholar 

  103. Guerit JM, Amantini A, Fischer C, Kaplan PW, Mecarelli O, Schnitzler A, et al. Neurophysiological investigations of hepatic encephalopathy: ISHEN practice guidelines. Liver Int. 2009;29:789–96.

    PubMed  Google Scholar 

  104. Amodio P, Marchetti P, Del Piccolo F, de Tourtchaninoff M, Varghese P, Zuliani C, et al. Spectral versus visual EEG analysis in mild hepatic encephalopathy. Clin Neurophysiol. 1999;110:1334–44.

    PubMed  Google Scholar 

  105. Weissenborn K, Scholz M, Hinrichs H, Wiltfang J, Schmidt FW, Kunkel H. Neurophysiological assessment of early hepatic encephalopathy. Electroencephalogr Clin Neurophysiol. 1990;75:289–95.

    PubMed  Google Scholar 

  106. Kugler CF, Lotterer E, Petter J, Wensing G, Taghavy A, Hahn EG, et al. Visual event-related P300 potentials in early portosystemic encephalopathy. Gastroenterology. 1992;103:302–10.

    PubMed  Google Scholar 

  107. Kugler CF, Petter J, Taghavy A, Lotterer E, Wensing G, Hahn EG, et al. Dynamics of cognitive brain dysfunction in patients with cirrhotic liver disease: an event-related P300 potential perspective. Electroencephalogr Clin Neurophysiol. 1994;91:33–41.

    PubMed  Google Scholar 

  108. Amodio P, Montagnese S, Gatta A, Morgan MY. Characteristics of minimal hepatic encephalopathy. Metab Brain Dis. 2004;19:253–67.

    PubMed  Google Scholar 

  109. Kircheis G, Wettstein M, Timmermann L, Schnitzler A, Haussinger D. Critical flicker frequency for quantification of low-grade hepatic encephalopathy. Hepatology. 2002;35:357–66.

    PubMed  Google Scholar 

  110. Romero-Gomez M, Cordoba J, Jover R, del Olmo JA, Ramirez M, Rey R, et al. Value of the critical flicker frequency in patients with minimal hepatic encephalopathy. Hepatology. 2007;45:879–85.

    PubMed  Google Scholar 

  111. Sharma P, Sharma BC, Puri V, Sarin SK. Critical flicker frequency: diagnostic tool for minimal hepatic encephalopathy. J Hepatol. 2007;47:67–73.

    PubMed  Google Scholar 

  112. O’Carroll RE. Neuropsychological aspects of liver disease and its treatment. Neurochem Res. 2008;33:683–90.

    PubMed  Google Scholar 

  113. Colombato L. The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension. J Clin Gastroenterol. 2007;41(S3):344–51.

    Google Scholar 

  114. Montagnese S, Schiff S, Catta A, Riggio O, Morgan MY, Amodio P. Hepatic encephalopathy: you should only comment on what you have actually measured. J Gastroenterol. 2010;45:342–3.

    PubMed  Google Scholar 

  115. Bajaj JS, Saeian K, Hafeezullah M, Hoffmann RG, Hammeke TA. Patients with minimal hepatic encephalopathy have poor insight into their driving skills. Clin Gastroenterol Hepatol. 2008;61:1135–9.

    Google Scholar 

  116. Randolph C. Repeatable Battery for the Assessment of Neuropsychological Status manual. San Antonio, TX: The Psychological Corporation; 1998.

    Google Scholar 

  117. Sorrell JH, Zolnikov BJ, Sharma A, Jinnai I. Cognitive impairment in people diagnosed with end-stage liver disease evaluated for liver transplantation. Psychiatry Clin Neurosci. 2006;60:174–81.

    PubMed  Google Scholar 

  118. Mooney S, Hasssanein TI, Hilsabeck RC, Ziegler EA, Carlson M, Maron LM, et al. Utility of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in patients with end-stage liver disease awaiting liver transplant. Arch Clin Neuropsychol. 2007;22:175–86.

    PubMed  Google Scholar 

  119. Butcher JN, Dahlstrom WG, Graham JR, Tellegen A, Kaemmer B. MMPI-2 (Minnesota Multiphasic Personality Inventory-2): manual for administration and scoring. Minneapolis: University of Minnesota Press; 1989.

    Google Scholar 

  120. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). Conceptual framework and item selection. Med Care. 1992;30:473–83.

    PubMed  Google Scholar 

  121. Younossi ZM, Guyatt G, Kiwi M, Boparai N, King D. Development of a disease specific questionnaire to measure health related quality of life in patients with chronic liver disease. Gut. 1999;45:295–300.

    PubMed  Google Scholar 

  122. Kim WR, Lindor KD, Malinchoc M, Petz JL, Jorgensen R, Dickson ER. Reliability and validity of the NIDDK-QA instrument in the assessment of quality of life in ambulatory patients with cholestatic liver disease. Hepatology. 2000;32:924–9.

    PubMed  Google Scholar 

  123. Gralnek IM, Hays RD, Kilbourne A, Rosen HR, Keeffe EB, Artinian L, et al. Development and evaluation of the liver disease quality of life instrument in persons with advanced, chronic liver disease-the LDQOL1.0. Am J Gastroenterol. 2000;95:3552–65.

    PubMed  Google Scholar 

  124. Zhou Y, Chen S, Jiang L, Guo C, Shen Z, Huang P, et al. Development and evaluation of the quality of life instrument in chronic liver disease patients with minimal hepatic encephalopathy. J Gastroenterol Hepatol. 2008;24:408–15.

    PubMed  Google Scholar 

  125. Reitan RM, Wolfson D. The Halstead-Reitan neuropsychological test battery: theory and clinical interpretation. 2nd ed. Tuscon, AZ: Neuropsychology Press; 1993.

    Google Scholar 

  126. Weissenborn K, Heidenreich S, Ennen J, Ruckert N, Hecker H. Attention deficits in minimal hepatic encephalopathy. Metab Brain Dis. 2001;16:13–9.

    PubMed  Google Scholar 

  127. Amodio P, Campagna F, Olianas S, Iannizzi P, Mapelli D, Penzo M, et al. Detection of minimal hepatic encephalopathy: normalization and optimization of the Psychometric Hepatic Encephalopathy Score. A neuropsychological and quantified EEG study. J Hepatol. 2008;49:346–53.

    PubMed  Google Scholar 

  128. Randolph C, Weissenborn K, Hilsabeck R, Kato A, Kharbanda P, Li Y, et al. Neuropsychological assessment of hepatic encephalopathy: International Society on Hepatic Encephalopathy and Nitrogen Metabolism (ISHEN) practice guidelines. Liver Int. 2009;29:629–35.

    PubMed  Google Scholar 

  129. Bajaj JS. Current and future diagnosis of hepatic encephalopathy. Metab Brain Dis. 2010;25:107–10.

    PubMed  Google Scholar 

  130. Bajaj JS, Saeian K, Verber MD, Hischke D, Hoffmann RG, Franco J, et al. Inhibitory control test is a simple method to diagnose minimal hepatic encephalopathy and predict development of overt hepatic encephalopathy. Am J Gastroenterol. 2007;102:754–60.

    PubMed  Google Scholar 

  131. Bajaj JS, Hafeezullah M, Franco J, Varma RR, Hoffmann RG, Knox JF, et al. Inhibitory control test for the diagnosis of minimal hepatic encephalopathy. Gastroenterology. 2008;135:1591–600.

    PubMed  Google Scholar 

  132. Amodio P, Ridola L, Schiff S, Montagnese S, Pasquale C, Nardelli S, et al. Improving the inhibitory control task to detect minimal hepatic encephalopathy. Gastroenterology. 2010;139:510–8.

    PubMed  Google Scholar 

  133. Ziegler EA, Hilsabeck RC, Carlson MD, Hassanein TI, Perry W. Resolution of cognitive impairment after liver transplantation: a case study [abstract]. Arch Clin Neuropsychol. 2001;16:738.

    Google Scholar 

  134. Franklin GM, Heaton RK, Nelson LM, Filley CM, Seibert C. Correlation of neuropsychological and MRI findings in chronic/progressive multiple sclerosis. Neurology. 1988;38:1826–9.

    PubMed  Google Scholar 

  135. Smith A. Symbol Digit Modalities Test (SDMT): manual (revised). Los Angeles, CA: Western Psychological Services; 1982.

    Google Scholar 

  136. Mattarozzi K, Campi C, Guarino M, Stracciari A. Distinguishing between clinical and minimal hepatic encephalopathy on the basis of specific cognitive impairment. Metab Brain Dis. 2005;20:243–9.

    PubMed  Google Scholar 

  137. Wechsler D. Wechsler Test of Adult Reading. San Antonio, TX: The Psychological Corporation; 2001.

    Google Scholar 

  138. Golden CJ, Freshwater SM. Stroop color and word test: revised examiner’s manual. Wood Dale, IL: Stoelting Co.; 2002.

    Google Scholar 

  139. Kaplan EF, Goodglass H, Weintraub S. The Boston Naming Test. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 1983.

    Google Scholar 

  140. Benton AL. Development of a multilingual aphasia battery: progress and problems. J Neurol Sci. 1969;9:39–48.

    PubMed  Google Scholar 

  141. Kongs SK, Thompson LL, Iverson GL, Heaton RK. Wisconsin Card Sorting Test-64 Card Version. Lutz, FL: Psychological Assessment Resources; 2000.

    Google Scholar 

  142. Matthews CG, Klove H. Instruction manual for the Adult Neuropsychology Test Battery. Madison, WI: University of Wisconsin Medical School; 1964.

    Google Scholar 

  143. Beck AT, Steer RA, Brown G. Beck Depression Inventory-II Manual. San Antonio, TX: Psychological Corporation; 1996.

    Google Scholar 

  144. Beck AT, Steer RA. Beck Anxiety Inventory: manual. San Antonio, TX: The Psychological Corporation; 1990.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Psychology Service, South Texas Veterans Health Care System, 7400 Merton Minter Blvd., San Antonio, TX, 78229, USA

    Robin C. Hilsabeck Ph.D., ABPP & Amy L. Webb M.D.

  2. Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    Robin C. Hilsabeck Ph.D., ABPP

  3. Department of Psychiatry, University of California, San Diego, San Diego, CA, USA

    Robin C. Hilsabeck Ph.D., ABPP

  4. Hepatology Clinic, South Texas Veterans Health Care System, San Antonio, TX, USA

    Amy L. Webb M.D.

  5. Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    Amy L. Webb M.D.

Authors
  1. Robin C. Hilsabeck Ph.D., ABPP
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amy L. Webb M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robin C. Hilsabeck Ph.D., ABPP .

Editor information

Editors and Affiliations

  1. East 72 Street, STE 500 428, New York, 10021, New York, USA

    Lisa D. Ravdin

  2. Miller School of Medicine, University of Miami, NW. 14th Street 1120, Miami, 33136, Florida, USA

    Heather L. Katzen

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Hilsabeck, R.C., Webb, A.L. (2013). Hepatic Encephalopathy. In: Ravdin, L., Katzen, H. (eds) Handbook on the Neuropsychology of Aging and Dementia. Clinical Handbooks in Neuropsychology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3106-0_29

Download citation

Publish with us

Policies and ethics

Search

Navigation