Table 1.

West Haven criteria and clinical description and ISHEN modifications^[1]

West-Haven criteria including MHE	ISHEN	Description	Suggestive operative criteria
	Covert		Abnormal tests without clinical manifestations.
Minimal		Alterations in psychometric or neuropsychological tests exploring attention, working memory, psychomotor speed, visuospatial ability and executive functions. No clinical neurological signs.
Grade I		Euphoria or anxiety, shortened attention span, impairment of addition or subtraction, altered sleep rhythm and lack of awareness.	Cognitive/behavioral decay with respect to his/her standard on clinical examination or to the caregivers.
	Overt	Lethargy or apathy, disorientation for time,	Disorientation for time (at least three of the following
Grade II		obvious personality changes, inappropriate behavior, dyspraxia, asterixis.	are wrong: day of the month, day of the week, month and season or year) ± the other mentioned symptoms.
Grade III		Somnolence to semi-stupor but response to stimuli, confusion, gross disorientation, bizarre behavior.	Disorientation also for space (at least three of the following are wrong: country, state or region, city or place) ± the other mentioned symptoms.
Grade IV		Coma	Lacking response to painful stimuli.