As the global population ages, more people face cognitive decline, with over 10 million new cases of dementia reported annually worldwide. However, a recent study reveals that up to 13 percent of dementia diagnoses in the United States might be misdiagnoses, with patients actually suffering from a treatable condition known as hepatic encephalopathy.
“Hepatic encephalopathy cognitive impairment caused by liver failure affects over 40 percent of patients with advanced liver disease (cirrhosis) and can be mistaken for dementia,” explains Virginia Commonwealth University hepatologist Jasmohan Bajaj. “Health care providers must be made aware of this potential overlap between dementia and hepatic encephalopathy, which is treatable.”
The liver is crucial for regulating various body chemicals, filtering blood, and aiding digestion. Factors like alcohol, hepatitis virus, high cholesterol, obesity, diabetes, stress, and aging can all damage the liver. However, with early detection and appropriate treatment, liver damage can be reversed, often through dietary and behavioral changes and emerging drug treatments.
Treatment of hepatic encephalopathy has already resolved cognitive impairments in some patients initially diagnosed with dementia. For instance, one patient’s wife observed a remarkable improvement in her husband’s condition, with memory loss, falls, tremors, and hallucinations all resolved.
Further supporting the potential for recovery, a recent mouse study suggested that the impacts of aging on the liver might be reversible if caught early. “We’ve shown that aging exacerbates non-alcoholic liver disease… and by reducing this impact, we can reverse the damage,” states Duke University hepatologist Anna Mae. “You are never too old to get better.”
Earlier this year, Bajaj and his team reviewed the medical records of 177,422 US veterans diagnosed with dementia between 2009 and 2019. Despite none being diagnosed with liver disease, over 10 percent had high fibrosis 4 (FIB-4) scores, indicating a high likelihood of cirrhosis.
In a follow-up study, Virginia Commonwealth University biostatistician Scott Silvey, Bajaj, and colleagues examined 68,807 medical records from a national database of non-veteran patients. They found an even higher prevalence of high FIB-4 scores, nearly 13 percent.
“The prevalences and determinants of a high FIB-4 are striking, including a greater proportion of patients who were not white in the high FIB-4 group,” notes Silvey and the team. “While we did not study the specific factors behind these disparities, a lack of access to therapy or medical care in both dementia care and comorbidity care could contribute.”
Liver malfunction stresses other tissues in the body, including the kidneys, pancreas, heart, and brain, highlighting the importance of liver health. “This important link between dementia and liver health emphasizes the importance of screening patients for potentially treatable contributors to cognitive decline,” concludes Bajaj.
As we continue to confront the rising tide of cognitive decline, ensuring accurate diagnoses and effective treatments could significantly improve the quality of life for millions affected by what could be a treatable condition.
