Background Minimal hepatic encephalopathy is a subclinical but significant neurological complication of cirrhosis that impairs attention, psychomotor speed, and executive function. Although it lacks overt symptoms, MHE (Minimal Hepatic Encephalopathy) adversely affects cognitive performance, daily functioning, and prognosis. It increases the risk of developing OHE (Overt Hepatic Encephalopathy), falls, and impaired driving. Early detection through psychometric testing is essential for timely intervention and improved patient outcomes. This study aims to determine the prevalence of MHE in cirrhotic patients attending a tertiary care center. Methods A cross-sectional study was conducted among 50 patients with clinically, radiologically, and biochemically confirmed cirrhosis attending the Internal Medicine and Gastroenterology departments at TD Government Medical College, Alappuzha. Only patients classified as Child-Pugh Class A and B were included. After initial screening using the MMSE (Mini-Mental State Examination >24), the PHES (Psychometric Hepatic Encephalopathy Score) was used to diagnose MHE, defined by at least two abnormal test results. Clinical data, liver function parameters, and neurological findings were recorded. Statistical analysis was conducted to identify significant associations. Results MHE was detected in 54% of patients. Prevalence was highest in those aged >61 years (88.9%, p = 0.039). Females showed a higher prevalence (63.6%) compared to males (51.3%), though this was not statistically significant (p = 0.468). MHE was significantly associated with jaundice (69.7% vs. 23.5%, p = 0.002), ascites (69.2% vs. 37.5%, p = 0.025), elevated serum creatinine (0.93 ± 0.28 mg/dL, p = 0.022), total bilirubin >3 mg/dL (73.1%, p = 0.012), and INR >2.3 (100%, p = 0.036). All PHES test components were significantly associated with MHE (p < 0.05), indicating their diagnostic utility. Conclusion This study reveals a high prevalence (54%) of minimal hepatic encephalopathy among cirrhotic patients, emphasizing the need for routine cognitive screening using tools like PHES. Early identification and treatment may prevent progression to overt hepatic encephalopathy, reduce complications, and improve quality of life and long-term outcomes.

Minimal Hepatic Encephalopathy; Psychometric Hepatic Encephalopathy Score; Cirrhosis; Cognitive Impairment; Hepatic Encephalopathy.