The Animal Naming Test (ANT) is an analysis of semantic fluency consisting of saying as many animal names as possible within one minute. A PHES score of greater than or equal to –5 is considered diagnostic of MHE in the Indian patients. The clinical impact of the FCT has already been assessed in large numbers of patients with MHE. FCT is used to assess the mental state and it surpasses the hurdles of the differences in language and the level of education and literacy of the person. The FCT and the NCT are similar in principle, but the numbers are substituted by figures. Due to concerns about some patients who are not acquainted with English alphabets and not able to perform NCT-B, it was replaced by the figure connection test (FCT-A). The PHES consists of a battery of six tests including the number connection test NCT-A, the NCT-B, digit symbol test, serial dotting test, and the line tracing test for time (t) and error (e). It can be performed in 10-15 minutes in an outpatient department.

The PHES has been extensively validated in German, Indian, Spanish, Italian and Romanian populations. Therefore, the present study was conducted to compare the prevalence of PHES, and ANT abnormalities in patients having cirrhosis without any evidence of overt hepatic encephalopathy (OHE) and to study the relationships of these abnormalities with the severity of liver disease and the development of OHE and survival on follow-up in an Indian population.

This Animal Naming Test (ANT) score was found to be accurate and directly correlated with Psychometric Hepatic Encephalopathy Score (PHES) as well as with different stages of HE. A standard simple verbal questionnaire was applied in a recent study in Italy for the rapid assessment of patients who do not have HE with frank disorientation. However, simple tests are needed for diagnosis of MHE given its sociomedical relevance. As there is no gold standard, most trusted methods that are frequently used to diagnose MHE include psychometric and neurophysiological tests. The present diagnostic criteria of MHE rely on the patient’s history, exclusion of other neurological diseases, detailed physical examination, and the results of neurophysiological and neuropsychological tests. Minimal hepatic encephalopathy (MHE) is a comparably low degree of cognitive impairment in patients having cirrhosis of the liver and is regarded at one end of the spectrum of HE rather than being a distinct entity.

Hepatic encephalopathy (HE) is characterized by a range of neuropsychiatric symptoms that occur in patients with chronic liver disease after the exclusion of already known neurological disorders.

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