Neuropsychological aspects of liver disease and its treatment.

Liver disease can lead to serious impairment in cognitive functioning, through the development of a condition known as hepatic encephalopathy (HE). While gross impairment is clinically obvious, milder variants of the condition may escape detection at bedside examination and yet may have a significant impact on day-to-day activities. In this brief review article, the neuropsychology of liver disease is examined, focusing on nature, aetiology and significance. The possible contributory role of endogenous benzodiazepines in HE is described, as is the evidence regarding the effect of benzodiazepine antagonism on cognitive functioning in HE. The functional localisation of HE is briefly reviewed, as is the use of neuropsychological measures to evaluate treatment efficacy, e.g. following shunt procedures or liver transplantation. Finally, living donor liver transplantation is described, and the case is made for rigorous longitudinal neuropsychological evaluation of potential donors and recipients.