Hepatic encephalopathy treatment may benefit people with hepatic encephalopathy. LOLA lowers ammonia levels by increasing the generation of urea through the urea cycle, a metabolic pathway that removes ammonia by turning it into the neutral substance urea. LOLA may be combined with lactulose and/or rifaximin if these alone are ineffective at controlling symptoms. In those with cirrhosis, the risk of developing hepatic encephalopathy is 20% per year, and at any time about 30–45% of people with cirrhosis exhibit evidence of overt encephalopathy. The prevalence of minimal hepatic encephalopathy detectable on formal neuropsychological testing is 60–80%; this increases the likelihood of developing overt
Proper adjective adjectives. In general, an adjective is capitalized if its meaning is "pertaining to "X"", where "X" is some specific person, place, language, or organized group. Most capitalized adjectives are derived from proper nouns; for example, the proper adjective "American" is derived from the proper noun "America". Sometimes, an adjective is capitalized because it designates an ethnic group with a shared culture, heritage, or ancestry. This usage asserts the existence of a unified group with common goals. For example, in Canadian government documents, "Native" and "Aboriginal" are capitalized. An adjective can lose its capitalization when it takes on new meanings, such