Patient Education
Patients should be aware of the spectrum of HE that ranges from overt to subclinical, the true prevalence of this condition is not well defined but is estimated to involve up to 60% of patients with cirrhosis. It has been recently reported that even a single episode of HE is associated with a persistent cognitive defect, suggesting that HE is not a truly reversible condition. Whereas overt HE can be demonstrated with a mental status exam, MHE requires complex psychometric testing of specific cognitive functions, including inhibition, attention, and working memory. Such testing is not widely available and certainly not commonly used in routine clinical practice. MHE has been associated with reductions in patient quality of life, and recently with an increased number of motor vehicle violations and auto accidents. Further complicating this association is the apparent poor insight that these patients have into their compromised driving skills.44