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The following review discusses some of the cognitive and functional problems in liver disease. Some medical literature is included which is consistent with difficulties reported by patients. Prevalence, possible causes, and types of liver disease are reviewed, including an outline of various complications associated with the disease. Hepatic encephalopathy (HE) is one such complication and a general background to this is given. It has been suggested that subgroups of patients with liver disease have mild cognitive deficits and demonstrate poorer performances on neuropsychological tests compared with matched controls. This has been termed minimal hepatic encephalopathy (MHE), a syndrome that occurs in patients with liver disease without overt symptoms of hepatic encephalopathy. The full spectrum of cognitive impairment in MHE is unknown (Collie, 2005). Research has attempted to understand the profile of cognitive deficits in patients with liver disease. Studies have investigated various areas of functioning (e.g. psychomotor skills, attention and memory) by neuropsychological testing. The main studies are presented in the review. Some of the limitations of the minimal hepatic encephalopathy hypothesis are discussed. There is some debate about possible causes of observed cognitive deficits and various psychological models including health (coping and quality of life) and clinical (mood issues) are proposed. Further research and clinical implications are also discussed.