Minimal hepatic encephalopathy (MHE) is mainly diagnosed using psychometric tests such as the psychometric hepatic encephalopathy score (PHES). Despite the clinical and social relevance of MHE, psychometric testing is not widespread in routine clinical care. We assessed the usefulness of the critical flicker frequency (CFF), for the diagnosis of MHE and for the prediction of the development of overt episodes of HE. The normal range of PHES in the Spanish population was evaluated in a control group. Subsequently, 114 patients with cirrhosis and 103 healthy controls underwent both PHES and CFF tests. A diagnosis of MHE was made when the PHES was lower than ؊4 points. Patients were followed-up every 6 months for a total of 1 year. CFF did not correlate with age, education, or sex in the control group. The mean CFF was significantly lower in patients with MHE versus non-MHE or controls. Mean CFF correlated with individual psychometric tests as well as PHES (r ‫؍‬ 0.54; P < 0.001). CFF <38 Hz was predictive of further bouts of overt HE (log-rank: 14.2; P < 0.001). There was a weak correlation between mean CFF and Child-Pugh score but not with model for end-stage liver disease score. In multivariate analysis using Cox regression, CFF together with Child-Pugh score was independently associated with the development of overt HE. Conclusion: CFF is a simple, reliable, and accurate method for the diagnosis of MHE. It is not influenced by age or education and could predict the development of overt HE. H epatic encephalopathy (HE) is a major complication of cirrhosis and is associated with a poor prognosis. 1,2 Minimal hepatic encephalopathy (MHE) is the first stage in the clinical spectrum of HE. 3,4 MHE is associated with an impaired quality of life, 5 and patients become unfit to safely drive a motor vehicle. 6 Moreover, patients with MHE and altered oral glutamine challenge have a shortened life span. 7 Although no definitive treatment is currently available, evaluating MHE in patients with cirrhosis could be recommended because of its prognostic value. Nevertheless, in a recent Spanish questionnaire, only 41% of hepatologists test for MHE in routine clinical practice. 8 The major obstacles to the evaluation of MHE include: (1) a lack of consensus diagnostic criteria; (2) the fact that most psychometric tests used in the diagnosis of MHE are time-consuming; (3) a lack of normal distribution values corrected for educational level and age; (4) the high cost of neurophysiological assessment; and (5) the need for experienced personnel and specialized equipment.The psychometric hepatic encephalopathy score (PHES) includes a battery of 5 psychometric tests that have been found useful for the diagnosis of MHE. In a recent consensus meeting, 9 the PHES was recommended as the gold standard in the diagnosis of MHE because: (1) it covered the spectrum of cognitive aspects that are affected in HE; (2) normative age-corrected data are available; and (3)

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Diet supplementation with BCAA after an episode of HE does not decrease recurrence of HE. However, supplementation with BCAA improves minimal HE and muscle mass. Identification of risk factors for recurrence of HE may allow the development of new preventive therapies that could decrease the neuropsychological sequelae of repeated episodes of HE.

Although the survival rate of patients undergoing orthotopic liver transplantation (OLT) is highly satisfactory, one of the most important objectives for liver transplantation teams at the present time is to achieve the best possible quality of life and psychosocial functioning for these patients after transplantation. We present the preliminary results of a study designed to determine which domains of psychosocial functioning are most affected in liver transplant recipients, and to examine the factors associated with poorer adjustment after OLT, using a utility-based standardized measure. Patients who had undergone liver transplant more than 12 months previously were eligible. They were administered the Psychosocial Adjustment to Illness Scale (PAIS), and they provided the answers themselves. Multivariate regression models showed that attitudes toward health care were poorer in women (␤ ‫؍‬ 0.916, P < .001), in patients who were employed at the moment of transplantation (␤ ‫؍‬ 0.530, P ‫؍‬ .032), and in patients of lower social class (␤ ‫؍‬ 0.722, P ‫؍‬ .026) than in men, unemployed patients, and patients of higher social class. Sexual functioning was worse in women (␤ ‫؍‬ 0.907, P ‫؍‬ .001) and older patients (␤ ‫؍‬ 0.999, P < .001) than in men or younger patients. Psychological distress was higher in women (␤ ‫؍‬ 0.981, P ‫؍‬ .001) than in men, and lower in currently employed patients (␤ ‫؍‬ -0.937, P ‫؍‬ .001) than in the unemployed. Only gender remained significantly associated with the total PAIS score (␤ ‫؍‬ 0.969, P < .001), with women showing a poorer overall psychosocial adjustment to OLT. In conclusion, there seems to be no doubt that liver transplantation improves quality of life, but special attention should be paid to female recipients, who seem to have more difficulty than their male counterparts in adjusting to the psychosocial consequences of the procedure. (Liver Transpl 2004;10:228 -234.)