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Minimalhepatic encephalopathy (MHE) has a negative effect on patients' dailyfunctioning. Thus far, no study has investigated the effect oftreatment-related improvement in cognitive functions on health-related qualityof life (HRQOL). We measured psychometric performance by number and figureconnection tests parts A and B, picture completion, and block design tests andHRQOL by the Sickness Impact Profile (SIP) of 90 patients with cirrhosis oninclusion into the study and 3 months later. A Z score less than -2 on theneuropsychological (NP) tests was considered abnormal. Sixty-one (67.7%)patients had MHE. They were randomly assigned in a 1:1 ratio to receive treatment(lactulose) for 3 months (n=31) or no treatment (n=30) in a nonblinded design.The mean number of abnormal NP tests decreased significantly in patients in thetreated group (baseline, 2.74 [95% CI 2.40-3.08]; after 3 months, .75 [95% CI.36-1.16]) compared with patients in the untreated group (baseline, 2.47 [95%CI 2.19-2.74]; after 3 months, 2.55 [95% CI 2.16-2.94]); multivariate analysisof variance (MANOVA) for time and treatment, P=0.001. The mean total SIP scoreimproved among patients in the treated group (baseline, 10.39 [95% CI9.36-11.43]; after 3 months, 3.77 [95% CI 2.52-5.02]) compared with patients inthe untreated group (baseline, 10.36 [95% CI 8.98-11.73]; after 3 months, 10.39[95% CI 8.36-12.42]); MANOVA for time and treatment, P=0.002. Improvement inHRQOL was related to the improvement in psychometry. CONCLUSION: Treatment withlactulose improves both cognitive function and HRQOL in patients with cirrhosiswho have MHE.Leggil'articolo