Not Dementia?... 'Silent Organ' Causing 'Delirium' Symptoms

US Research Team Investigates Medical Records of 170,000
"Treatable Hepatic Encephalopathy May Be Mistaken for Dementia"

About 10% of people diagnosed with dementia have undiagnosed liver disease, and brain damage caused by this may have accelerated cognitive decline, according to a study.

On the 3rd (local time), HealthDay News reported that Dr. Yasmohan Bajaj, a gastroenterology specialist at the Richmond Veterans Medical Center in the United States, and his research team examined the medical records of 177,422 veterans diagnosed with dementia between 2009 and 2019 (average age 78) and obtained these results.

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Liver failure refers to a condition where liver function deteriorates due to viral hepatitis or non-alcoholic fatty liver disease, which causes toxins to accumulate in the blood. These toxins can enter the brain and cause hepatic encephalopathy (HE). Hepatic encephalopathy can also cause delirium, symptoms similar to dementia. When delirium occurs, sudden cognitive decline such as reduced attention and language ability, as well as psychotic disorders, arise. Along with this, patients may experience hallucinations, auditory hallucinations, anxiety, tremors, restlessness, insomnia, and excessive behaviors such as shouting. Because of this, hepatic encephalopathy can be mistaken for dementia.

Dementia is irreversible, but hepatic encephalopathy can be treated with drugs that remove toxins from the blood. However, if hepatic encephalopathy is left untreated, it can lead to coma and death. If hepatic encephalopathy is misdiagnosed as dementia, treatment for hepatic encephalopathy is delayed, increasing the risk.

The research team discovered hepatic encephalopathy in two men diagnosed with dementia and Parkinson's disease, and after treating hepatic encephalopathy, they recovered from dementia and Parkinson's disease, which prompted the study. Additionally, when reviewing the medical records of 177,422 veterans diagnosed with dementia between 2009 and 2019, 10.3% had a Fibrosis-4 (FIB-4) score of 2.67 or higher, indicating ongoing liver fibrosis. Five percent had a FIB-4 score of 3.25 or higher, indicating cirrhosis. Liver fibrosis is a condition where liver cells harden due to liver damage. However, none of the study subjects had a prior diagnosis of liver disease or history of cirrhosis. The team also examined 80 dementia patients at the Richmond Veterans Medical Center's geriatric clinic, finding that 9 of them (11.2%) had a FIB-4 score of 2.67 or higher.

Regarding this, the research team emphasized, "Clinicians need to be aware that there may be a connection between dementia and liver health," and "It is important to keep in mind that an irreversible dementia diagnosis may overlap with treatable hepatic encephalopathy." The study results were published online in JAMA Network Open, the journal of the American Medical Association.

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