One in eight people diagnosed with dementia ‘may have liver disease instead’

Cognitive symptoms are similar to those caused by hepatic encephalopathy, which is caused by cirrhosis and is treatable

One in eight people diagnosed with dementia may actually be suffering symptoms from a liver disease, a study suggests.
The cognitive symptoms of dementia are similar to those caused by the condition hepatic encephalopathy (HE) which is caused by liver cirrhosis.
Viral infection, heavy alcohol consumption and obesity can all lead to the disease which causes scarring on the organ.
The condition can lead to confusion, forgetfulness, shaking and slurred speech as toxins build up in the bloodstream and impact the brain because the liver can not clean them out properly.
Scientists analysed the medical records of more than 68,000 patients in a database of American people who were diagnosed with dementia between 2009 and 2019.
The average age was 72 and scientists analysed each person’s records to calculate how likely it was they actually had undiagnosed HE caused by liver cirrhosis.
Data show that 12.8 per cent of patients in the cohort were likely suffering from an undiagnosed case of cirrhosis.
“Risk factors for potential undiagnosed cirrhosis include alcohol use disorder and viral hepatitis,” the scientists write.
“In up to 13 per cent of patients with dementia, treatable hepatic encephalopathy might contribute to the cognitive impairment.”
The findings are in line with a previous study which found ten per cent of veterans with dementia may have actually had HE caused by cirrhosis.
Hepatic encephalopathy can be treated with medication and the symptoms reversed, scientists say, unlike dementia which is a disease that progressively worsens.
“We need to increase awareness that cirrhosis and related brain complications are common, silent, but treatable when found,” said study author Dr Jasmohan Bajaj from Virginia Commonwealth University.
“Undiagnosed cirrhosis and potential hepatic encephalopathy can be a treatable cause of or contributor towards cognitive impairment in patients diagnosed with dementia.”
Data showed that having viral hepatitis more than doubled the likelihood of a person having cirrhosis, while alcohol abuse increased risk by 39 per cent.
But while the liver condition and dementia have “symptom overlap”, according to the study authors, some experts believe that the subtle differences in the conditions would allow a doctor to tell the difference.
Dr Rob Howard, professor of old age psychiatry at University College London, told the MailOnline: “Full-blown hepatic encephalopathy looks different to dementia.
“The symptoms of hepatic encephalopathy fluctuate in a way that Alzheimer’s doesn’t and anyone working in a memory clinic will be familiar with that.
“No one should be diagnosed with dementia without physical causes for their confusion being excluded.”
He added: “Simple tests should always be done and these include a liver function test.
“But I don’t think it’s credible to say people with dementia have been misdiagnosed, based on this evidence.”
The study is published in The American Journal of Medicine.