A Narrative Review Of Minimal Hepatic Encephalopathy

Minimal hepatic encephalopathy (MHE) is primarily a cognitive disorder linked to chronic liver disease that often remains underdiagnosed due to the subtlety of its clinical manifestations. These symptoms are frequently overlooked or dismissed as inconsequential in clinical practice, leading to many undiagnosed cases. The standard neurological examination is usually normal in indi-viduals with MHE. Regular and systematic screening for MHE is essential for early detection, which can improve cognitive outcomes and prevent progression to a more serious and debilitat-ing condition also known as overt hepatic encephalopathy. The pathophysiology of MHE is very complex and multifactorial, involving several interplaying mechanisms. Mainly, hyperammone-mia, system-wide inflammation, gut-derived neurotoxins, oxidative stress, and mitochondrial dysfunction are at its root. Any of these factors may interfere with the normal functioning of neu-rotransmitters, giving rise to the typical subtle cognitive impairments that are hallmarks of MHE. The Animal Naming Test and EncephalApp-Stroop tests are useful for screening for minimal en-cephalopathy in office or bedside settings. The role potentially played by emerging diagnostic technologies of advanced neuroimaging and biomarkers has been reviewed, underscoring its promise in improving early detection and diagnosis of MHE.