July 23, 2024 -- Patients with dementia may instead have a specific brain disorder and should be tested for cirrhosis, one of the main causes of the condition, new research suggests.
The study of more than 68,000 people diagnosed with dementia between 2009 and 2019 found that almost 13% had test scores typical of cirrhosis and potentially the brain disorder known as hepatic encephalopathy.
The findings, recently published online in The American Journal of Medicine, are in line with the researchers' previous work, which showed that about 10% of U.S. veterans with a dementia diagnosis may in fact have hepatic encephalopathy.
"We need to increase awareness that cirrhosis and related brain complications are common, silent, but treatable when found," one of the study authors, Jasmohan Bajaj, MD, of Virginia Commonwealth University and Richmond VA Medical Center, said. "Moreover, these are being increasingly diagnosed in older individuals."
"Cirrhosis can also predispose patients to liver cancer and other complications, so diagnosing it in all patients is important,” he said.
'Easy to Miss'
Commenting on the research Nancy Reau, MD, section chief of hepatology at Rush University Medical Center in Chicago, said it is easy for doctors to miss liver disease that could progress and lead to cognitive decline.
"Most of my patients are already labeled with liver disease; however, it is not uncommon to receive a patient from another specialist who felt their presentation was more consistent with liver disease than the issue they were referred for," she said.
Still, even with metabolic disorders the condition isn't advanced enough in most patients to cause symptoms similar to those of dementia, said Reau, who was not associated with the study.
"It is more important for specialists in neurology to exclude liver disease and for hepatologists or gastroenterologists to be equipped with tools to exclude alternative explanations for neurocognitive presentations," she said. "It is important to not label a patient as having HE and then miss alternative explanations."
