Background: Hepatitis C virus (HCV) infection is one of the main causes of chronic liver disease worldwide. It has been shown that up to 50% of patients with chronic HCV infection experience neuropsychiatric issues. Objective: This study aimed to evaluate the cognitive impairment, extrapyramidal signs and their effects on patients' quality of life. Patients and Methods: The study included 60 untreated patients (20 chronic hepatitis, 40 patients with liver cirrhosis) and 20 healthy controls matched for age, sex, and educational level. Cirrhotic patients were graded according to the Child-Pugh classification. Patients underwent a thorough clinical and neurological evaluation, liver function tests, hepatitis markers, abdominal ultrasonography, psychometric tests and auditory p300 evoked potentials. Unified Parkinson's Disease Rating Scale (UPDRS) and chronic liver disease questionnaire (CLDQ) were used. Results: Patients had significant cognitive impairment that became greater with increased severity of liver disease. The extrapyramidal manifestations were absent in chronic hepatitis while present in cirrhotics and their frequencies were increased with cirrhotic severity (P~0.001). P300 latency was delayed in patients with and without extrapyramidal signs. Quality of life measured by CLDQ was significantly lower in all patients than controls (P~ 0.001), and became worse with increased severity of liver disease except worry increased in chronic hepatitis. Conclusion: Patients with HCV infection had cognitive impairment, which increased with chronic liver disease (CLD) severity. Extrapyramidal signs were absent in chronic hepatitis patients, while, present in cirrhotics and increased with increasing severity of cirrhosis. Cognitive impairment was not attributed to the extrapyramidal affection. The CLD and cognitive impairment had negative impact on the quality of life.