Ammonia can cross the blood-brain-barrier in the form of uncharged ammonia or the ionized NH4+ form by passive diffusion and active transport, respectively. In patients with liver failure, hyperammonemia is present and is considered to play a significant role in the pathogenesis of HE.
The pathogenesis of HE is complex and not yet fully elucidated. The current article also provides the point of view of several specialists in cognitive computation and decision support systems (authors PD, JuG, MG). We discuss several studies which employed means of artificial intelligence in diagnosing MHE, and we propose an artificial intelligence analysis of common behavioral patterns, such as speech or handwriting, as a possible screening option for MHE. This review focuses on the diagnostic approach to the minimal hepatic encephalopathy, which is a challenging subject with large areas of uncertainty on the one hand and pronounced clinical needs and consequences on the other.
Cognitive decline, attention deficit, loss of working memory, and visuomotor coordination also lead to higher frequency of falls and driving accidents. MHE affects the lives of both patients and caregivers by lowering the quality of life and worsening socioeconomic status. Hepatic encephalopathy should be classified according to the severity of clinical manifestation as either covert (CHE) or overt (OHE) (ISHEN classification International Society for Hepatic Encephalopathies and Nitrogen Metabolism) or as Minimal HE (MHE) and grade I–IV HE (WHC West Haven criteria), while the term “covert” includes both minimal and grade I HE.
The European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD) defined hepatic encephalopathy (HE) as a brain dysfunction caused by liver insufficiency and/or portosystemic shunting it manifests as a spectrum of neurological or psychiatric abnormalities ranging from subclinical alterations to coma.
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