A recent study conducted by researchers from Virginia Commonwealth University has revealed the misdiagnosis of hepatic encephalopathy in older U.S. veterans with dementia. Hepatic encephalopathy, a treatable and potentially reversible condition, is often mistaken for dementia, leading to inadequate treatment. The study emphasizes the importance of screening patients with cognitive impairment for liver disease.
Individuals with cirrhosis often experience hepatic encephalopathy, which can cause symptoms such as mental slowing, tremors, confusion, and coma. The liver’s inability to clear toxins from the gut and resulting inflammation affect brain function. Given the potential overlap between hepatic encephalopathy and dementia in the veteran population, the researchers decided to investigate further.
The researchers analyzed the medical records of over 177,000 U.S. veterans diagnosed with dementia but not cirrhosis between 2009 and 2019. They focused on the Fibrosis-4 (FIB-4) score, a tool used to assess liver disease risk. Surprisingly, 10.3% of veterans with dementia had high FIB-4 scores, indicating a high likelihood of cirrhosis.
These findings highlight the necessity of screening patients for treatable causes of cognitive decline. Identifying and treating hepatic encephalopathy in individuals with cirrhosis has the potential to improve their mental function. Additionally, screening for cirrhosis is crucial as it puts patients at a higher risk for other complications, such as liver cancer.
The study also revealed disparities in the diagnosis of cirrhosis in veterans with dementia, particularly among those living in urban areas, of Hispanic descent, and non-white individuals. This emphasizes the need to address disparities and educate patients, family members, and clinicians about the risk of cirrhosis and dementia.
The researchers plan to replicate this study in a non-veteran population and explore biomarkers for diagnosing the presence of dementia, cirrhosis-related problems, or both. This research provides a potentially useful screening tool for identifying patients with reversible or treatable underlying causes of dementia. It also highlights the need for better tools, awareness, and education to alert providers about the possibility of hepatic encephalopathy mimicking dementia.
In summary, the study conducted by researchers from Virginia Commonwealth University has uncovered the misdiagnosis of hepatic encephalopathy in older U.S. veterans with dementia. Screening patients with cognitive impairment for liver disease is crucial, as early detection and treatment can potentially improve their mental function. Additionally, addressing disparities in the diagnosis of cirrhosis and educating healthcare providers about the possibility of hepatic encephalopathy in patients with dementia-like symptoms is essential.