Rapid identification system of frontal dysfunction in subclinical hepatic encephalopathy

Introduction & Aim: Liver disease is associated with cognitive dysfunction also at early stages and minimal hepatic encephalopathy, affecting 20-70% of patients, is frequently under-recognised. The main purpose of this work is to demonstrate that a huge number of patients, enrolled due to acute confusional state, without any clinical diagnosis, presented hepatic encephalopathy. Material & Methods: 410 acute confusional state subjects, not diagnosed before, have been enrolled in this study, due to the further subsequent diagnosis of well compensated liver diseases; among them 237 (57.8%) have hepatic alterations, acute, subacute or chronic. Results: Even in acute minimal hepatic sufferance the psychometric tests applied demonstrated precocious signs of cerebral frontal alteration, which become more evident while they have their clinical pathway, transforming themselves, in minimal hepatic failure or chronic liver disease. Conclusions: In conclusion, these instruments are essential to detect even very precocious and totally subclinical frontal failure and can be a good instrument to follow these patients and to give a valid score for the chronic liver disease, in relation to frontal alterations.