Minimal hepatic encephalopathy (MHE) is a category of early HE without any overt neuropsychiatric symptoms but with subtle cognitive deficits (Ferenci et al., 1998). It is a common complication of cirrhosis and has been reported in 20% to 74% of patients (Dhiman et al., 2010), depending on the test used for diagnosis. It results in deficits in specific cognitive domains such as attention, vigilance, response inhibition, executive function and prospective memory. These deficits are often not apparent from a routine neurological exam or MMSE but can be detected on psychometric testing. The prompt identification and treatment of MHE are essential because MHE predicts progression to overt HE and impairs the capacity to drive which can have a significant impact on patients' quality of life (Romero-Gomez et al., 2001; Wein et al, 2004) .