Current approach to treatment of minimal hepatic encephalopathy in patients with liver cirrhosis

Table 1 Classification of the different stages of hepatic encephalopathy

Diagnostic criteria	Classification stages
ISHEN	Unimpaired	Covert hepatic encephalopathy		Overt hepatic encephalopathy
WHC		MHE	Grade I	Grade II	Grade III	Grade IV
	No encephalopathy, no history of OHE	Imperceptible cognitive alterations during routine clinical examination	Trivial lack of awareness; Euphoria or anxiety; Shortened attention span; Impairment of addition or subtraction; Altered sleep rhythm	Lethargy or apathy; Disorientation for time; Obvious personality change; Inappropriate behavior; Dyspraxia asterixis	Somnolence to semistupor; Responsive to stimuli; Confused; Gross disorientation; Bizarre behavior	Coma

ISHEN: International Society for Hepatic Encephalopathy and Nitrogen Metabolism; MHE: Minimal hepatic encephalopathy; OHE: Overt hepatic encephalopathy; WHC: West Haven Criteria.