Treatment of HE with or without liver transplantation has been shown to reverse the cognitive deficits and improve quality of life (Prasad et al., 2007; Sidhu et al., 2011). Although the PHES and NCT are the gold standard for diagnosing MHE, their utility is limited due to expensive copyright, a need for trained psychologists and the lack of reimbursements from insurance companies. A simpler test would therefore be beneficial to internists who could easily implement it in the clinic setting.