Assessing cognitive decline for effective screening: evaluating the efficacy of mini-mental status examination and Addenbrooke’s cognitive examination in identifying minimal hepatic encephalopathy in patients with compensated liver cirrhosis

Background: Liver cirrhosis is a progressive disease marked by significant liver scarring and functional impairment. Minimal hepatic encephalopathy (MHE), a common complication, has a global prevalence of 30-84%, and in India, up to 59.7% among cirrhosis patients. Despite its prevalence, routine MHE screenings are infrequent, highlighting a significant gap in cirrhosis management. This study aims to evaluate the efficacy of the mini-mental status examination (MMSE) and the Addenbrooke’s cognitive examination (ACE) in early detection of cognitive impairments in liver cirrhosis patients. Methods: The study assessed cognitive function in 126 participants (63 males with compensated liver cirrhosis and 63 healthy male controls) using MMSE and ACE. Logistic regression analysis was employed to explore the relationship between cognitive impairment and MHE. Results: MMSE scores were significantly lower in the cirrhosis group (M=23.73, SD=1.74) compared to controls (M=25.61, SD=1.07), indicating cognitive impairments, especially in orientation and language domains. ACE scores also showed a significant decline in the cirrhosis group (M=80.92, SD=2.66) compared to controls (M=84.98, SD=3.06), particularly in visuospatial abilities. Conclusions: MHE significantly affects cognitive function in compensated liver cirrhosis patients. Both MMSE and ACE are effective in detecting cognitive impairments, with ACE showing greater sensitivity. Routine cognitive screening using ACE could improve early detection and intervention, enhancing cognitive function and quality of life for cirrhosis patients.