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TO recent study of American veterans found that 10% of those diagnosed with dementia actually had a liver condition called hepatic encephalopathy or HE, a treatable condition.
The liver can be damaged by several things, including alcohol, fatty deposits, and hepatitis viruses. When damage continues over several years, the liver becomes scarred (known as cirrhosis) and, at a certain point, it can no longer perform one of its critical tasks: detoxifying the blood. Toxins (mainly ammonia) can build up and reach the brain, interfering with its function. This is the.
HD can be very mild and difficult to diagnose. Symptoms It can be as subtle as changes in sleep pattern or irritability. As the condition worsens, symptoms such as forgetfulness, disorientation, or confusion arise. In its most severe form, it can cause coma and death.
Once diagnosed, it can be treated, initially with laxatives that help eliminate ammonia and other toxins that accumulate in the intestine. This is followed by treatment with an antibiotic (rifaximin) that kills some of the harmful ammonia-producing bacteria in the intestine. If very severe, HD may even be a reason to undergo a liver transplant.
Silent condition
HD is easier to detect and treat if we know that the person has cirrhosis. The problem is that cirrhosis is a silent condition until it reaches very advanced stages when the liver begins to fail. HD is much more difficult to diagnose in the general population. Symptoms of change in mood, behavior, confusion and forgetfulness are also seen in people with dementia.
Dementia It is a condition caused by long-term damage to brain function. This is most commonly caused by a reduced blood supply to the brain due to damage to small blood vessels due to diabetes or high blood pressure (vascular dementia). Other forms of dementia include Alzheimer diseasewhere deposits damage the brain causing typical symptoms of forgetfulness and confusion.
The new US study examined the medical records of former soldiers treated by the Veterans Health Administration for 10 years with a diagnosis of dementia made on at least two separate occasions.
The team analyzed clinical data, including blood results from this group, and used it to calculate a FIB-4 score (a score based on liver blood results and age), which can be used to predict liver damage. More than 175,000 people were included in the analysis. Of these, 10% (18,390 people) had a FIB-4 score greater than 3.25 (an accepted cutoff for the diagnosis of liver scarring).
The researchers found that a high FIB-4 score was more common in people with viral hepatitis and heavy alcohol users, risk factors for liver disease.
A high score was less likely in people who had diabetes, high blood pressure or kidney disease, all risk factors for dementia. This suggests that people with a high FIB-4 score may actually have liver disease and HD causes their symptoms rather than dementia.
The researchers confirmed these findings by looking at a separate group of people who were screened for dementia at their hospital and found similar results, with 9% having a high FIB-4 score and possible cirrhosis.
This study suggests that around 10% of people diagnosed with dementia may have underlying silent liver disease in which HD causes or contributes to symptoms, an important diagnosis since HD is treatable.
new avenue
It is the first study of its kind to analyze routinely collected health data in this way. However, we must treat these results with some caution.
First, the data comes from military veterans (97% male and 80% white ethnicity) and is therefore not representative of the general population. Second, FIB-4 was used as a marker of cirrhosis. It is a useful score that is easily calculated, but accuracy It depends on the cause of the liver disease and is lower in older people. Finally, having a high FIB-4 score does not necessarily mean that the person has HD.
This study opens a new and important avenue of research. Raise awareness about the need to screen for liver disease in people with general symptoms of dementia. This is likely to be a growing problem as rates of dementia and cirrhosis increase. But we still need better data to fully understand the number of people with HD who are incorrectly diagnosed with dementia and how best to identify and treat them.
Ashwin Dhanda is an associate professor of hepatology at the University of Plymouth.
This article was first published in The conversation.