As the world’s population ages, more and more people, or their loved ones, will experience significant cognitive decline. Each year, there are more than 10 million new cases of dementia worldwide.
But a new study suggests that up to 13 percent of people diagnosed with dementia in the United States may be misdiagnosed and suffer from treatable conditions.
“Healthcare providers need to be aware that there may be an overlap between dementia and hepatic encephalopathy, which is treatable,” says Jasmohan Bajaj, a liver specialist at Virginia Commonwealth University.
Hepatic encephalopathy (cognitive impairment caused by liver failure) affects more than 40 percent of patients with advanced liver disease (cirrhosis). The brain damage caused by hepatic encephalopathy can be difficult to distinguish from dementia.
Our liver regulates the levels of most chemicals in our body by filtering chemicals from the blood and aiding in digestion.
It is well known that alcohol damages the liver, but other factors that pose risks to the liver include hepatitis viruses, high cholesterol, obesity, diabetes, stress, aging, etc. However, liver damage is reversible if detected early and treated appropriately.
Many of these can be alleviated through dietary and behavioral changes, and there are many more drug treatments on the horizon.
In fact, treatment of hepatic encephalopathy has reversed cognitive impairment in at least two patients who had been diagnosed with dementia.
“He’s a different person!” said the wife of one of his patients after his memory loss, falls, tremors and hallucinations were all cured.
Recent studies in mice suggest that the effects of ageing on the liver may also be reversible if detected early.
“We know that aging worsens nonalcoholic liver disease, and by mitigating this effect, we can reverse the damage,” explains Anna May, a hepatologist at Duke University. “You’re never too old to get better.”
So earlier this year, Bajaj and his colleagues looked at the medical records of 177,422 US veterans who had been diagnosed with dementia between 2009 and 2019.
Although none of them had been diagnosed with liver disease, the team found that more than 10 percent had a high fibrosis-4 (FIB-4) score, a measure of scarring in the liver, indicating a high likelihood of cirrhosis.
In the new study, biostatistician Scott Silvey of Virginia Commonwealth University, Bajaj, and colleagues repeated the survey using 68,807 medical records from a national database of non-veteran patients to examine whether the previous results reflect the general U.S. population.
Surprisingly, there were even more patients with high FIB-4 scores in this population, about 13 percent.
“The prevalence and determinants of high FIB-4 were surprising, including a high proportion of non-white patients in the high FIB-4 group,” Silvey and team explained.
“While we did not look at the specific factors behind these disparities, it is possible that lack of access to treatment and healthcare, both in dementia care and comorbidity care, plays a role.”
A malfunctioning liver puts strain on other systems in the body, including the kidneys, pancreas, heart and brain, so it makes sense to prioritize liver health.
“This significant association between dementia and liver health highlights the importance of screening patients for potentially treatable factors that may contribute to cognitive decline,” Bajaj concludes.
The study was published in the American Journal of Medicine.
