الفهرس 
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Abstract
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Summary
Hepatic encephalopathy reflects a spectrum ofneuropsychiatric abnormalities seen in patients with liver dysfunction,after exclusion of other known brain disease(Ferenci et al. 2002).
HE is divided into two primary components:
Overt HE (OHE) and minimal HE(MHE).OHE can be diagnosed clinically through a constellation of signs and symptoms,whereas MHE requires specialized testing.MHE is manifested by impairment in specialized testing and is considered by most of the clinicians to be a pre-clinical stage of OHE(Poordad2007).
Approximately 60-80% of patients with cirrhosis tested have evidence of cognitive dysfunction or MHE.This condition is associated with increased progression to OHE,poor quality of life and a high risk of traffic violations and accidents (Bajaj et al. 2008).
Minimal hepatic encephalopathy (MHE) is the mildest form of spectrum of hepatic encephalopathy (HE), the patients with MHE have no recognizable clinical symptoms of HE but have mild cognitive and psychomotor deficits. The prevalence of MHE is high in patients with cirrhosis of liver and varies between 30% and 84%; it is higher in patients with poor liver function (Kircheis et al. 2002).
The diagnostic criteria for MHE have not been standardized but rest on careful patient history and physical examination, normal mental status examination, demonstration of abnormalities in cognition and/or neurophysiological function and exclusion of concomitant neurological disorders(Wein et al. 2004).
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MHE is associated with impaired health-related quality of life, predicts the development of overt HE and is associated with poor survival. Hence, screening all patients with cirrhosis for MHE using psychometric tests, and treatment of those patients diagnosed to have MHE has been recommended.
MHE is an important disorder that impairs patients daily functioning and HRQoL. Complex activities involving attention, information processing and psychomotor skills such as driving a car, planning a trip, are mainly affected; However the basic activities of daily life, such as shopping, dressing, personal hygiene, etc are preserved(Prasad et al. 2007).
The specific nature of cognitive dysfunction in MHE results in a disproportionate impairment of workers engaged in “blue-collar” professions compared to “white-collar” professionals. This is essential to remember because cirrhotic patients engaged in professions that require constant vigilance and coordination, e.g. machinery operators and drivers are affected by MHE more severely compared to those who have predominantly verbal and intellectual functions, such as administrative and company executives(Bajaj et al. 2008).
It is recognized that a battery of tests, that measure multiple cognitive domains, is more reliable than a single test. Cognitive dysfunction in MHE is characterized by attention deficit, problems with working/short-term memory, and response inhibition. Testing strategies are therefore focused on these domains (Montgomery & Bajaj2011).
The current definition of MHE is based on psychometric test results of two standard deviations (SD) less than normal on at least two psychometric tests(Mullen 2007).
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The Porto systemic Encephalopathy (PSE) Syndrome Test (or Psychometric Hepatic Encephalopathy Score [PHES]) was designed to detect MHE and includesNCT-A, NCT-B, line-tracing test, serial-dotting test, and the DST. The PHES has shown high specificity for HE and isrecommended in the evaluation of MHE patients (Randolph et al. 2009).
Patients and methods
This study was conducted on 50 cirrhotic patients. They were selected from outpatients departement of Shebin El Koum Fever Hospital and fuculty of medicine hospital Menoufia University during the period from march 2014 to febreuary 2015. They include 40 male, and 10 female; their age ranged from 25 to 65 years with a mean age of (50.4 ± 6.8).
results
The results showed the frequency of psychometric test results in which positive results constituted 80% however normal ones were 20%.
Conclusion
from the results of the present study we can conclude the following:
1- The incidence of minimal hepatic encephalopathy in patients with liver cirrhosis is about 80%.
2- Psychometric tests (PHES) and EEG are important in diagnosis of MHE, but PHES is earlier, more sensitive and more diagnostic than EEG.