Skip to main content
SpringerLink
Log in

Impact and Diagnosis of Minimal or Grade 1 Hepatic Encephalopathy

  • Chapter
  • First Online:
Diagnosis and Management of Hepatic Encephalopathy

Abstract

Two case stories are presented to illustrate how and in whom minimal and grade 1 hepatic encephalopathy should be diagnosed. By definition the use of psychometric or neurophysiological tests is necessary for identifying minimal HE and such tests are also very useful for description of grad 1 HE. We put emphasis on how to apply and interpret the tests in clinical practise, i.e. in patients with differing cognitive prerequisites and co-morbid diseases. Further, the case stories highlight how fluctuating minimal and grade 1 HE impinges on the lives of patients and caregivers.

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 59.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 79.99
Price excludes VAT (USA)
  • Compact, lightweight 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. Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology. 2014;60(2):715–35.

    Article  PubMed  Google Scholar 

  2. Gluud LL, Vilstrup H, Morgan MY. The effect of treatment for hepatic encephalopathy with nonabsorbable disaccarides on morbidity and mortality in patients with cirrhosis: systematic review and meta-analysis. In: Jalan R, editor. EASL International Liver Congress 2015; Vienna. ILC 2015 Abstract Book: EASL; 2015. p. 175.

    Google Scholar 

  3. Lauridsen MM, Thacker LR, White MB, Unser A, Sterling RK, Stravitz RT, et al. In patients with cirrhosis, driving simulator performance is associated with real-life driving. Clin Gastroenterol Hepatol. 2016;14(5):747–52.

    Article  PubMed  Google Scholar 

  4. Yildirim M. Falls in patients with liver cirrhosis. Gastroenterol Nurs. 2017;40(4):306–10.

    Article  PubMed  Google Scholar 

  5. Lauridsen MM, Mikkelsen S, Svensson T, Holm J, Kluver C, Gram J, et al. The continuous reaction time test for minimal hepatic encephalopathy validated by a randomized controlled multi-modal intervention—a pilot study. PLoS One. 2017;12(10):e0185412.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Lauridsen MM, Schaffalitzky de Muckadell OB, Vilstrup H. Minimal hepatic encephalopathy characterized by parallel use of the continuous reaction time and portosystemic encephalopathy tests. Metab Brain Dis. 2015;30(5):1187–92.

    Article  CAS  PubMed  Google Scholar 

  7. Lauridsen MM, Poulsen L, Rasmussen CK, Hogild M, Nielsen MK, de Muckadell OB, et al. Effects of common chronic medical conditions on psychometric tests used to diagnose minimal hepatic encephalopathy. Metab Brain Dis. 2015;31(2):267–72.

    Article  PubMed  Google Scholar 

  8. Lauridsen MM, Frojk J, de Muckadell OB, Vilstrup H. Opposite effects of sleep deprivation on the continuous reaction times in patients with liver cirrhosis and normal persons. Metab Brain Dis. 2014;29(3):655–60.

    Article  PubMed  Google Scholar 

  9. Lauridsen MM, Thiele M, Kimer N, Vilstrup H. The continuous reaction times method for diagnosing, grading, and monitoring minimal/covert hepatic encephalopathy. Metab Brain Dis. 2013;28:231–4.

    Article  CAS  PubMed  Google Scholar 

  10. Lauridsen MM, Gronbaek H, Naeser EB, Leth ST, Vilstrup H. Gender and age effects on the continuous reaction times method in volunteers and patients with cirrhosis. Metab Brain Dis. 2012;27:559–65.

    Article  PubMed  Google Scholar 

  11. Lauridsen MM, Jepsen P, Vilstrup H. Critical flicker frequency and continuous reaction times for the diagnosis of minimal hepatic encephalopathy: a comparative study of 154 patients with liver disease. Metab Brain Dis. 2011;26(2):135–9.

    Article  PubMed  Google Scholar 

  12. Weissenborn K. Neuropsychological characterization of hepatic encephalopathy. J Hepatol. 2001;34:768–73.

    Article  CAS  PubMed  Google Scholar 

  13. Lauridsen MM, Bajaj JS. Hepatic encephalopathy treatment and driving: a continental divide. J Hepatol. 2015;63:287–8.

    Article  PubMed  Google Scholar 

  14. Schomerus H, Hamster W. Neuropsychological aspects of portal-systemic encephalopathy. Metab Brain Dis. 1998;13(4):361–77.

    Article  CAS  PubMed  Google Scholar 

  15. Amodio P, Montagnese S, Spinelli G, Schiff S, Mapelli D. Cognitive reserve is a resilience factor for cognitive dysfunction in hepatic encephalopathy. Metab Brain Dis. 2017;32(4):1287–93.

    Article  PubMed  Google Scholar 

  16. Patel AV, Wade JB, Thacker LR, Sterling RK, Siddiqui MS, Stravitz RT, et al. Cognitive reserve is a determinant of health-related quality of life in patients with cirrhosis, independent of covert hepatic encephalopathy and model for end-stage liver disease score. Clin Gastroenterol Hepatol. 2015;13(5):987–91.

    Article  PubMed  Google Scholar 

  17. Bajaj JS, Wade JB, Gibson DP, Heuman DM, Thacker LR, Sterling RK, et al. The multi-dimensional burden of cirrhosis and hepatic encephalopathy on patients and caregivers. Am J Gastroenterol. 2011;106(9):1646–53.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Jepsen P, Ott P, Andersen PK, Sorensen HT, Vilstrup H. Clinical course of alcoholic liver cirrhosis: a Danish population-based cohort study. Hepatology. 2010;51(5):1675–82.

    Article  PubMed  Google Scholar 

  19. Sharma P, Sharma BC, Agrawal A, Sarin SK. Primary prophylaxis of overt hepatic encephalopathy in patients with cirrhosis: an open labeled randomized controlled trial of lactulose versus no lactulose. J Gastroenterol Hepatol. 2012;27:1329–35.

    Article  CAS  PubMed  Google Scholar 

  20. Ladegaard Gronkjaer L, Hoppe Sehstedt T, Norlyk A, Vilstrup H. Overt hepatic encephalopathy experienced by individuals with cirrhosis: a qualitative interview study. Gastroenterol Nurs. 2017; https://doi: 10.1097/SGA.0000000000000286. [Epub ahead of print]

  21. 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(1):45–9.

    Article  CAS  PubMed  Google Scholar 

  22. Orr JG, Homer T, Ternent L, Newton J, McNeil CJ, Hudson M, et al. Health related quality of life in people with advanced chronic liver disease. J Hepatol. 2014;61(5):1158–65.

    Article  PubMed  Google Scholar 

  23. Marchesini G, Bianchi G, Amodio P, Salerno F, Merli M, Panella C, et al. Factors associated with poor health-related quality of life of patients with cirrhosis. Gastroenterology. 2001;120(1):170–8.

    Article  CAS  PubMed  Google Scholar 

  24. Barboza KC, Salinas LM, Sahebjam F, Jesudian AB, Weisberg IL, Sigal SH. Impact of depressive symptoms and hepatic encephalopathy on health-related quality of life in cirrhotic hepatitis C patients. Metab Brain Dis. 2016;31(4):869–80.

    Article  PubMed  Google Scholar 

  25. Kircheis G, Knoche A, Hilger N, Manhart F, Schnitzler A, Schulze H, et al. Hepatic encephalopathy and fitness to drive. Gastroenterology. 2009;137(5):1706–15.e1–9.

    Article  PubMed  Google Scholar 

  26. Wein C, Koch H, Popp B, Oehler G, Schauder P. Minimal hepatic encephalopathy impairs fitness to drive. Hepatology. 2004;39(3):739–45.

    Article  PubMed  Google Scholar 

  27. 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(4):1175–83.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Urios A, Mangas-Losada A, Gimenez-Garzo C, Gonzalez-Lopez O, Giner-Duran R, Serra MA, et al. Altered postural control and stability in cirrhotic patients with minimal hepatic encephalopathy correlate with cognitive deficits. Liver Int. 2017;37(7):1013–22.

    Article  CAS  PubMed  Google Scholar 

  29. Soriano G, Roman E, Cordoba J, Torrens M, Poca M, Torras X, et al. Cognitive dysfunction in cirrhosis is associated with falls: a prospective study. Hepatology. 2012;55(6):1922–30.

    Article  PubMed  Google Scholar 

  30. Tips for preventing falls. Am Fam Physician. 2017;96(4): https://www.aafp.org/afp/2017/0815/p240-s1.html

  31. Bajaj JS, Heuman DM, Sterling RK, Sanyal AJ, Siddiqui M, Matherly S, et al. Validation of EncephalApp, Smartphone-Based Stroop Test, for the Diagnosis of Covert Hepatic Encephalopathy. Clin Gastroenterol Hepatol. 2015;13(10):1828–1835.e1.

    Article  PubMed  Google Scholar 

  32. Bajaj JS, Thacker LR, Heuman DM, Fuchs M, Sterling RK, Sanyal AJ, et al. The Stroop smartphone application is a short and valid method to screen for minimal hepatic encephalopathy. Hepatology. 2013;58(3):1122–32.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kircheis G, Hilger N, Haussinger D. Value of critical flicker frequency and psychometric hepatic encephalopathy score in diagnosis of low-grade hepatic encephalopathy. Gastroenterology. 2014;146(4):961–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Hospital of South West Jutland, Esbjerg, Denmark

    Mette Munk Lauridsen

  2. Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark

    Hendrik Vilstrup

Authors
  1. Mette Munk Lauridsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hendrik Vilstrup
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mette Munk Lauridsen .

Editor information

Editors and Affiliations

  1. McGuire VA Medical Center, Virginia Commonwealth University, Richmond, Virginia, USA

    Jasmohan S. Bajaj

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Lauridsen, M.M., Vilstrup, H. (2018). Impact and Diagnosis of Minimal or Grade 1 Hepatic Encephalopathy. In: Bajaj, J. (eds) Diagnosis and Management of Hepatic Encephalopathy. Springer, Cham. https://doi.org/10.1007/978-3-319-76798-7_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-76798-7_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-76797-0

  • Online ISBN: 978-3-319-76798-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation