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Some People Diagnosed With Dementia May Actually Have Liver Disease

2 months, 1 week ago

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Posted on Mar 08, 2024, 5 p.m.

A recent study of American Veterans published in JAMA Network Open found that 10% of those diagnosed with dementia actually had a treatable liver condition called hepatic encephalopathy (HE). Hepatic encephalopathy can be mild and difficult to diagnose, symptoms can be as subtle as changes in sleep patterns and irritability. As this condition worsens, symptoms progress to include forgetfulness, disorientation, or confusion which could be mistaken for general symptoms of dementia. If not treated in its most severe form, HE can cause coma and death.

The liver has a unique capacity to regenerate itself after damage, it can even regrow to a normal size after up to 90% of it has been removed. But this amazing organ is not invincible, and several things like alcohol, fatty deposits, and hepatitis viruses can damage it. When damage continues over several years the liver can become scarred (cirrhosis) and at a certain point, it will no longer be able to perform essential tasks like detoxifying the blood. When toxins build up, they can make their way into the brain and interfere with brain function, and this is what happens in HE. 

Once HE has been diagnosed initially laxatives are used to help remove the ammonia and other toxins that have built up, and then this is followed with antibiotic treatment to kill some of the harmful ammonia-producing bacteria in the gut. However, if the condition progresses and becomes severe it may become a reason to have a liver transplant. 

Hepatic encephalopathy is easier to detect and treat if it is discovered that the person has cirrhosis, but the other problem is that cirrhosis is another silent condition until it reaches the late stage as the liver starts to fail. In general, HE is hard to diagnose in the general population, sharing some symptoms that are similar to what is also seen in those with dementia such as changes in behavior, mood, confusion, and forgetfulness. 

For this study, the researchers examined clinical data including blood results from the medical records of over 175,000 former soldiers with a diagnosis of dementia who were treated at the Veterans Health Administration over ten years. The data was used to calculate an FIB-4 score which can be used to predict liver damage. The analysis revealed that 10% of the Veterans had a FIB-4 score of more than 3.25, which is an accepted cut-off for diagnosing liver scarring. 

According to the researchers, a high FIB-4 score was more common among those with viral hepatitis and heavy alcohol drinkers, which are also risk factors for liver disease. High scores were less likely among those with diabetes, high blood pressure, or kidney disease, which are all risk factors for dementia. These findings suggest that those with a high FIB-4 score may have liver disease with hepatic encephalopathy causing their symptoms that could be mistaken for dementia. 

The researchers took their investigation a step further and confirmed their findings by examining a separate group of people who were assessed at the hospital for dementia and found similar results, with 9% of this group having a high FIB-4 score and potential cirrhosis. Taken together, the results of this study suggest that around 10% of people currently diagnosed with dementia may have an underlying silent liver disease with hepatic encephalopathy causing and/or contributing to their symptoms, which is an important diagnosis because Hepatic encephalopathy is treatable whereas there is no cure for dementia. 

It was noted that FIB-4 scores were used as a marker of cirrhosis, and while it is easily calculated, the accuracy depends on the cause of liver disease, and it is lower in older people. Additionally, having a high FIB-4 score does not necessarily mean that the person has hepatic encephalopathy. However, the findings open new paths for research and raise awareness of the importance of checking for liver disease in those with general symptoms of dementia as the population continues to age. 

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