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By: Maria-Paula
Researchers from the Virginia Commonwealth University’s School of Medicine and the Richmond VA Medical Center have published a report showing that about 13% of individuals diagnosed with dementia may be suffering from reversible cognitive disorder caused by liver disease.
The researchers reviewed 177,422 U.S. veteran’s medical records diagnosed with dementia between 2009 and 2019. It showed that 10.3% of veterans with dementia had high FIB-4 scores and were very likely to have cirrhosis.
Almost 13% of the patients with dementia had high scores that are used to estimate the level of scarring of liver tissue, meaning they were very likely to have cirrhosis.
The recent publishment in the new analysis of non-veteran patients, the American Journal of Medicine, corroborates and extends the research group’s earlier work, JAMA Network Open in January, showing that about 10% of U.S. veterans diagnosed with dementia may instead be suffering from cirrhosis.
Cirrhosis is a chronic liver disease characterized by scarring of the liver tissue, leading to various liver complications, including hepatic encephalopathy, HE. This is a condition where the liver’s impaired function affects brain function, hence cognitive decline, confusion, and altered consciousness
Although cirrhosis often coexists with other conditions such as alcohol use disorder or hepatitis C that can independently affect cognition, sometimes, it can be difficult for physicians to differentiate dementia from hepatic encephalopathy. If undetected, patients may not receive treatment that can help improve their conditions.
Diagnosing cirrhosis-related cognitive decline can be challenging because it shares symptoms with other forms of dementia. Neuropsychological testing and ruling out other causes are therefore essential.
The liver is a key organ for optimum human health. When it doesn’t function properly, toxins build up in the blood. These toxins can travel to the brain, affect brain function, and leave patients confused. Widely available medications can readily rid the body of toxins and reverse this condition, but without treatment, patients can lapse into a coma or die.
Cirrhosis also causes the liver to struggle in processing ammonia, leading to its build-up in the bloodstream. Elevated ammonia levels affect brain cells and contribute to cognitive impairment.
Cognitive ability can also be affected with chronic inflammation and oxidative stress linked to cirrhosis, which negatively impacts brain health by damaging neutrons.
The new VCU-VA research report suggests that even without a cirrhosis diagnosis, specialists treating both veteran and non-veteran patients with dementia should include liver disease assessment. Early detection of cirrhosis may reverse cognitive impairment, potentially improving patients’ lives.
“This important link between dementia and liver health emphasizes the importance of screening patients for potentially treatable contributors to cognitive decline,” said the study’s corresponding author, Jasmohan Bajaj, M.D., a gastroenterologist with the VCU Stravitz-Sanyal Institute for Liver Disease and Metabolic Health and the Richmond VA Medical Center.
“Early detection of liver issues, which can contribute to the treatable cognitive decline known as hepatic encephalopathy, in those with dementia could help ensure that patients get access to targeted and appropriate therapies It should not be difficult to incorporate liver assessments into routine care for patients, as their risk for liver disease can be easily evaluated with an initial, noninvasive screening tool called the FIB-4 index,” added Bajaj.
Leading liver, gastroenterology, and endocrinology associations recommend the FIB-4 score as a first-line test to screen for liver fibrosis. The test was developed by Bajaj’s VCU Health colleague and co-author on the new study, Richard Sterling, M.D. is based on many measurements, including age. Sterling, M.D. Sterling is the chief clinical officer of the Stravitz-Sanyal Institute for Liver Disease and Metabolic Health.
Other co-authors of the paper are Scott Silvey, of VCU’s School of Population Health; Evan French, of VCU’s C. Kenneth and Dianne Wright Center for Clinical and Translational Research; Michael Godschalk, M.D., and Angela Gentili, M.D., of the Division of Geriatric Medicine in VCU’s School of Medicine and the Richmond VA Medical Center; and Nilang Patel, M.D., of the Division of Nephrology in VCU’s School of Medicine and the Richmond VA Medical Center.
Two older veterans who were thought to have dementia and Parkinson’s disease sparked Bajaj’s interest in the connection between dementia and cirrhosis, whose symptoms dramatically improved after being treated for HE In 2023, it was estimated that about 8% of U.S. veterans with cirrhosis had dementia while about 30% of veterans suffer some form of liver disease.
Old age, being male, congestive heart failure, viral hepatitis, alcohol use, and certain health conditions are some of the factors that increase an individual’s risk for cirrhosis. In the new analysis’ findings, non-veterans were unexpectedly more at risk than veterans.
“The 13% rate we found in non-veterans was surprising in that it was higher than we found among veterans, who tend to be older, less diverse and more male. Ultimately, it confirms and extends the results in a database more reflective of the U.S. population,” he said.
Bajaj who has spent the past several years focusing on hepatic encephalopathy and the gut-brain axis said the next step is to ensure that health care providers are made aware of this potential confusion between dementia and hepatic encephalopathy, which is treatable.
