New Research Highlights Overlooked Link Between Cognitive Decline, Liver Disease

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New Research Highlights Overlooked Link Between Cognitive Decline, Liver Disease

Some dementia diagnoses might actually stem from undiagnosed liver disease, according to a recent study.

Researchers at Virginia Commonwealth University’s School of Medicine and Richmond VA Medical Center recently published a study in the American Journal of Medicine regarding the link between cognitive decline and severe liver disease.

The study examined 69,000 non-veteran patients diagnosed with dementia between 2009 and 2019, with 13% reporting high scores used in screening for liver disease. That indicates they may have not received the right diagnosis.

Earlier research found that 10% of U.S. military veterans diagnosed with dementia may have instead battled cirrhosis.

“Our plea is to providers who are taking care of patients with dementia to see if hepatic encephalopathy could be a potential contributor because it is very easily treatable,” said Jasmohan Bajaj, M.D., a gastroenterologist with the VCU Stravitz-Sanyal Institute for Liver Disease and Metabolic Health and the Richmond VA Medical Center.

Without early detection indicators, patients living with cirrhosis could suffer further cognitive decline and face a critical health event with the wrong diagnosis.

Differentiating between complex liver disease and dementia is one of the greatest challenges facing medical researchers and physicians who care for older adults, according to Bajaj.

Bajaj believes that screening for liver disease in a dementia patient or older adult experiencing cognitive decline could be done quickly and efficiently as part of their health care plan with their respective general practitioner.

“What we found is that people that have cirrhosis, it’s very difficult for us to differentiate if they’re older whether they have dementia or if this is a complication of cirrhosis called hepatic encephalopathy,” Bajaj told Memory Care Business. “Unfortunately, dementia and chronic hepatic encephalopathy have similar neurological symptoms.”

What led Bajaj to study the interconnected nature of liver disease and dementia was a unique case involving two patients who were originally diagnosed with dementia but were treated for hepatic encephalopathy and made a full recovery.

Patients with hepatic encephalopathy don’t necessarily have memory problems but develop visual and spatial cognitive issues, one of the reasons those with liver disease could be misdiagnosed with dementia.

Researchers also found that those with cirrhosis above the age of 65 had “a different kind of brain structure” if they had memory problems along with different microbes present in their digestive tract. Those with both pre-dementia and related cognitive issues caused by cirrhosis were also found to have “felt worse,” which allowed researchers to differentiate between those with cirrhosis and those with dementia.

“One part of it might be treatable, and that might be enough to give patients years of life, or at least brain function, so that they can put either their affairs in order, talk to people [or] be responsive,” Bajaj said. “We want to actually bring that back and show that there’s still life left and that people can enjoy and do things that give them joy.”

Bajaj added that integrating liver assessments into routine patient care is straightforward and a solution that could help older adults living with liver disease and dementia. The risk for liver disease can be quickly evaluated using the FIB-4 index, which is a simple and noninvasive screening tool that can identify liver issues.

By using a screening tool in a patient’s health care journey, physicians could be able to differentiate between diseases and identify treatments sooner, rather than risk a misdiagnosis. To help those with cognitive decline, Bajaj said he and VCU colleagues have developed smartphone applications to simplify medication management.

“We want to ensure that not only the patient but also their family members are with them throughout this process, and we don’t want to overwhelm them with information,” Bajaj said. “What we need to do is focus on upcoming therapies to determine their risk-benefit ratio, and always be good communicators and advocates for our patients.”

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