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• Posted February 1, 2024

Could Many Cases of 'Dementia' in Men Be Liver Cirrhosis Instead?

A new study of aging U.S. veterans finds that one in every 10 who have been diagnosed with dementia might actually have brain impairments caused by liver cirrhosis.

It's a condition called hepatic encephalopathy, and it's often treatable, explained a team led by Dr. Jasmohan Bajaj, of the the Richmond VA Medical Center in Virginia.

Misdiagnosis as dementia may be delaying treatment of hepatic encephalopathy for far too many.

"Early detection of liver issues allows for targeted interventions and opens avenues for addressing treatable factors contributing to cognitive decline," Bajaj said. He's a leading expert in hepatic encephalopathy, and he also works at the Stravitz-Sanyal Institute for Liver Disease and Metabolic Health, part of Virginia Commonwealth University.

Liver cirrhosis -- a gradual scarring and dysfunction of liver tissue -- can have many contributing factors. These include age, being male, alcohol use, viral hepatitis, congestive heart failure and other health conditions.

Research has shown that about 30% of veterans have some form of liver disease.

Liver cirrhosis, in particular, can affect the brain. Hepatic encephalopathy occurs when a dysfunctional liver allows a buildup of toxins in the blood that then make their way to the brain.

That, in turn, can trigger episodes of delirium or confusion that might resemble dementia, the researchers noted.

However, while dementia is almost impossible to reverse, hepatic encephalopathy is very reversible with medications that cleanse the blood of toxins.

Without such treatment, patients with hepatic encephalopathy can lapse into coma and even die.

So, "this unexpected link between dementia and liver health emphasizes the importance of screening patients for potentially treatable contributors to cognitive decline," Bajaj said.

The latest study was sparked by cases Bajaj has seen firsthand. Two older male patients were diagnosed as having dementia with concurrent Parkinson's disease. But once their hepatic encephalopathy was detected and treated both recovered, with one patient recovering to the point where he was able to start driving again, Bajaj said.

In the new study, Bajaj's team reviewed the medical records of over 177,000 U.S. veterans who'd been diagnosed with dementia between 2009 and 2019. None of the patients had received a cirrhosis diagnosis.

The vast majority of veterans were male and averaged 78 years of age. They were assessed using a standard measurement of liver health.

Bajaj and colleagues found that 10.3% of veterans diagnosed with dementia also scored poorly on the measurement of liver health, meaning that they most likely had underlying cirrhosis. These trends were higher among Black and Hispanic veterans compared to whites.

The findings were published Jan. 31 in the journal JAMA Network Open.

A similar, follow-up study at the Richmond VA Medical Center uncovered similar results: 11.2% of the patients with dementia also had high FIB-4 scores, a measure of liver health. 

How can more of these cases of cirrhosis masquerading as dementia be revealed?

Bajaj believes that routinely measuring the health of patients' livers would be a start.

Doing so, "could help a significant number of patients, families and physicians by providing an opportunity to treat and potentially reverse cognitive impairment brought on by liver disease," he said.

The bottom line, according to Bajaj, is that doctors need to be "aware of a potential overlap [of dementia diagnoses] with hepatic encephalopathy, which is treatable."

More information

Find out more about hepatic encephalopathy at the Liver Foundation.

SOURCE: Virginia Commonwealth University, news release, Jan. 31, 2024