Diagnosing Minimal Hepatic Encephalopathy

Inclusion criteria

for patients with liver cirrhosis:

• Age> 18
• Liver cirrhosis verified by biopsy or appropriate clinic and biochemistry as well as imaging.
• Written informed consent
• Speaks and understands Danish

For the subgroup with liver cirrhosis and normal cognition:

• Normal result in PSE and CRT testing and clinical examination without evidence of HE

For the subgroup with liver cirrhosis and minimal hepatic encephalopathy:

• Abnormal result in PSE and / or CRT test, but oriented in time, place and own data.

For the subgroup with liver cirrhosis and HE grade 2, the following applies:

• Abnormal PSE and CRT result and / or disoriented in time, place or own data and / or asterixis or other clinical symptoms of HE
• Ability to collaborate on the performance of CRT test, PSE test and EEG

Inclusion criteria

healthy:

• Liver healthy
• Age over 18 years
• Formal education ≤ 14 years
• Written informed consent
• Speaks and understands Danish

Inclusion criteria

for pre-cirrhosis liver disease:

As for healthy controls plus:

• In our local outpatient clinic
• Proven pre-cirrhosis liver disease

Exclusion criteria

• Organic brain disease (eg previous epilepsy, apoplexy, dementia)
• Hyponatraemia (Na <124 mmol / L)
• Sepsis one week prior to tests.
• Heart failure (EC less than 30% or NYHA class III and IV)
• Severe chronic obstructive pulmonary disease (GOLD stage 3 and 4 ie FEV1 / FVC below 0.7 and FEV1 <50% of expected value)
• Highly controllable diabetes (HbA1C> 60 mmol / mol)
• Renal failure (eGFR below 60)
• Known neurological diseases (epilepsy, stroke, dementia)
• Intake of coffee or alcohol 6 hours before tests and change of dose in psychoactive drugs within 6 days of the test (morphine, antipsychotics, antidepressants) -