Cirrhosis — not dementia — may be causing cognitive decline in 13% of patients

Around 13% of patients with a dementia diagnosis may instead have advanced liver disease — also called cirrhosis — which can cause reversible cognitive decline, researchers at the Virginia Commonwealth University School of Medicine and the Richmond VA Medical Center found.

This new study, published June 26 in the American Journal of Medicine, expands on research previously published in January, which found that about 10% of U.S. veterans thought to have dementia may suffer from cirrhosis instead. 

The reversible cognitive decline is also called Hepatic encephalopathy. It is associated with patients who have cirrhosis and occurs when the liver is unable to remove toxins from the blood, which can interfere with consciousness and brain function. But distinguishing between hepatic encephalopathy and dementia is challenging because their symptoms overlap, the researchers wrote. 

For the study, they looked at 68,807 patients with a dementia diagnosis who had no prior cirrhosis diagnosis, and sufficient lab results for the Fibrosis-4 Index, which measures liver disease. From this group, 7.6% of patients had a FIB-4 index score that was 3.25 or higher, and 12.8% had a score of 2.67 or higher, which researchers found to be indicative of a higher likelihood of having cirrhosis.

Those with higher FIB-4 scores were also more commonly males with congestive heart failure, viral hepatitis, and alcohol use disorder, according to the data.

"This important link between dementia and liver health emphasizes the importance of screening patients for potentially treatable contributors to cognitive decline," Jasmohan Bajaj, MD, a gastroenterologist at the VCU Stravitz-Sanyal Institute for Liver Disease and Metabolic Health and the Richmond VA Medical Center, said in the news release.

The research also underscores the importance of using the FIB-4 index to "to screen for potential undiagnosed cirrhosis in patients with dementia," Dr. Bajaj and his co-authors wrote in their conclusion. They note physicians would also pay attention to "hepatic encephalopathy that might be misdiagnosed as dementia or cause worsening of cognitive function in patients with dementia."

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