There is a great unmet clinical need for improved screening for MHE in patients with cirrhosis. We will demonstrate that the Flicker-App can be used in clinic as well as at home by patients with cirrhosis to measure CFF, a proven screening test for MHE. We will optimize the protocol, software, and hardware of the Flicker-App to create a product appropriate for production and distribution to patients

SA 1. Determine whether cirrhotic patients (n=75) can self-administer the Flicker-App in clinic supervised by a research assistant and calculate the level of agreement between the CFF determined by the Flicker-App, the CFF determined by the "gold-standard" FFS device, and the test scores on the EncephalApp Stroop test.

SA 2. Determine whether cirrhotic patients (n=75) can self-administer the Flicker-App at home, including daily measurements over 1 week and weekly measurements over 6 weeks, and calculate the adherence to this protocol and the variability of these CFF measurements.

SA3. Make any necessary software or hardware adjustments to the Flicker-App to facilitate and simplify its self-administration by patients based on structured interview-questionnaires with the study participants and with clinical Gastroenterologists/Hepatologists

Inclusion Criteria:

• Cirrhosis (standard criteria)
• Chronic liver disease

Exclusion Criteria:

• Grade III or IV hepatic encephalopathy
• Mini-mental state examination score ≤25 (suggestive of dementia)
• alcohol or illicit drug use within 3 months
• current use of benzodiazepines
• antiepileptics or psychotropic drugs
• color blindness
• severe vision impairment (blindness, macular degeneration).

Cirrhosis patients without Grade III or IV OHE