Hepatic encephalopathy can be mistaken for dementia in many cases: Study

USA: Individuals with compromised brain function could be mistakenly diagnosed with dementia instead of hepatic encephalopathy which is commonly associated with liver Cirrhosis, recent research reveals.

A study published in The American Journal of Medicine reports that the fibrosis (FIB-4) index could be utilized as a potential biomarker to investigate undiagnosed cirrhosis in patients with dementia and that hepatic encephalopathy which is associated with cirrhosis is misdiagnosed as dementia.

Dementia is an untreatable condition that affects the memory and thinking ability of an individual and these symptoms coincide with the symptoms associated with hepatic encephalopathy which is a potentially reversible condition. Around 5-10 % of patients with undiagnosed cirrhosis are mistakenly diagnosed with dementia and may have hepatic encephalopathy

Scott Silvey, Department of Population Health, Virginia Commonwealth University, and colleagues conducted a retrospective cohort study between 2009 and 2019 using the FIB - 4 index as a biomarker for screening cirrhosis in non-veteran patients with dementia.

Using national non-veteran patient data from the multi-center TriNetX database, researchers allocated 68,807 patients diagnosed with dementia at two or more physician visits. Patients had no prior diagnosis of cirrhosis. The team measured the prevalence of 2 FBI-4 index at 2 cut-off points i.e. >2.67 and >3.25 for predicting liver cirrhosis in dementia patients.

Results revealed as:

• Within the cohort (44.7% male, 78.0% white, mean age 72.73 years, 7.6% (n = 5815) had a FIB-4 index >3.25

• 12.8% (n=8683) had FIB-4 >2.67

• In multivariable logistic regression models, FIB-4 > 3.25 was associated with male gender, congestive heart failure, viral hepatitis, alcohol use disorder, and chronic kidney disease.

• FIB-4 > 3.25 is inversely associated with white race and diabetes.

In conclusion, researchers suggest that the FBI-4 index could be used for screening undiagnosed cirrhosis in patients with dementia and also hepatic encephalopathy could be mistaken for dementia because of overlapping symptoms.

Reference: Silvey S, Sterling RK, French E, Godschalk M, Gentili A, Patel N, Bajaj JS. A Possible Reversible Cause of Cognitive Impairment: Undiagnosed Cirrhosis and Potential Hepatic Encephalopathy in Patients with Dementia. Am J Med. 2024 Jun 26:S0002-9343(24)00398-X. doi: 10.1016/j.amjmed.2024.06.014. Epub ahead of print. PMID: 38942345.