This chapter talks about a 59-year-old woman who was presented with gradual onset of cognitive symptoms including deficits in memory, attention, spatial orientation, and difficulties with task planning and execution. Brain imaging showed generalized atrophy and sub-cortical white matter disease. The likelihood of an underlying neurodegeneration was supported by her apparent cognitive decline prior to the onset of the liver disease, the prominent short term memory deficit, and a family history of dementia. This lady clearly demonstrates many of the features of hepatic encephalopathy (HE), including quantified liver disease and response to protein restriction and lactulose therapy. However, she also has features of Alzheimer's disease, with memory and language deficits, family history, and imaging supportive of this diagnosis. Hence, she was thought to have two mutually exacerbating disorders. HE is a neuropsychiatric disorder characterized by the insidious onset of impaired attention, altered personality, and irregular sleep patterns.