Summary Background/ Aim: Hepatic encephalopathy (HE), both overt and minimal, forms a continuum of cognitive change in cirrhosis. Strategies to diagnose and treat HE have evolved considerably. This review focuses on the updated diagnostic and treatment strategies for HE. Methods: Techniques for the clinical, psychometric and neuro-physiological evaluation of HE are reviewed. The methods reviewed include pure clinical scales (West-Haven), psychometric tests (PSE-syndrome test), neuro-physiological tests (EEG, Critical flicker frequency, CFF) and computerized tests (Inhibitory control test, ICT). Results: Clinical scales are limited while psychometric tests (specifically PSE-syndrome test), CFF and ICT can be used to diagnose MHE. However, there is no single test that can capture the entire spectrum of cognitive impairment. Treatment options and goals depend on the acuity of HE. Inpatient management should concentrate on supportive care, precipitating factor reversal and lactulose and/or rifaximin therapy. Outpatient therapy should aim to prevent recurrences and both lactulose and rifaximin have evidence to support their use. Conclusions: Diagnostic techniques for HE range from simple scales to sophisticated tools. Treatment options depend on the stage of HE. The future challenge is to evaluate cognitive function as a continuum with clinically relevant outcomes and to develop well-tolerated and inexpensive treatments for HE.