A RECENT study has found that up to 13% of patients with dementia may have undiagnosed cirrhosis, potentially contributing to their cognitive decline. This underdiagnosed condition, hepatic encephalopathy (HE), is an easily treatable cause of cognitive impairment, according to the researchers.
Jasmohan Bajaj, Virginia Commonwealth University School of Medicine, USA, and team highlighted the growing concern of underdiagnosed cirrhosis in an ageing population. “We found a 10% rate of undiagnosed cirrhosis in veterans with dementia but wanted to extend this to nonveterans,” Bajaj explained.
The retrospective cohort study analysed 68,807 nonveteran patients diagnosed with dementia between 2009 and 2019. These patients, with a mean age of 72.73 years, had no prior diagnosis of cirrhosis. The researchers focused on the FIB-4 index, a marker used to identify advanced liver fibrosis, examining two critical thresholds: >2.67 and >3.25.
The findings revealed that 7.6% of the patients had a FIB-4 index >3.25, while 12.8% had an index exceeding 2.67, suggesting that 13% of dementia patients could have undiagnosed cirrhosis. Bajaj emphasised that HE, a condition associated with cirrhosis, could be a treatable contributor to their cognitive decline, and could therefore become a key factor that clinicians check for.
The study also identified several risk factors linked to a higher likelihood of elevated FIB-4 scores, including hepatitis B or C infection, congestive heart failure, HIV, male sex, chronic kidney disease, and alcohol use disorder. Conversely, white race and diabetes were associated with lower odds of an elevated FIB-4.
Bajaj urged healthcare providers to consider the potential overlap between dementia and HE, as early diagnosis and treatment of cirrhosis could significantly improve patients’ brain function and overall quality of life.
Victoria Antoniou, EMJ
Reference
Silvey S et al. A possible reversible cause of cognitive impairment: undiagnosed cirrhosis and potential hepatic encephalopathy in patients with dementia. Am J Med. 2024;DOI:10.1016/j.amjmed.2024.06.014.
