**5. Clinical significance**

MHE has a significant impact on daily activities. It decreases patients' quality of life (QoL) [43, 44] and driving impairment due to the attention and visuomotor coordination deficits [45–47]. The Sickness Impact Profile was studied in a group of patients with cirrhosis to evaluate QoL indicators such as sleep, rest, eating, work, home management, recreation, ambulation, daily care, movement, and emotional behavior. All scales were significantly decreased in patients with MHE compared

with individuals without MHE [48]. Moreover, those patients suffer from falls [49] and have a high risk of development of episodic HE [2].
