One in 10 dementia patients could see some of their symptoms alleviated by treating an underlying liver problem, an intriguing new study suggests.
One of the main ones of the liver. Its function is to filter toxic substances, such as ammonia and manganese, from the blood that can alter communication between brain cells.
But when the organ fails, in a condition called liver cirrhosis (or liver scarring), these compounds remain in the blood and can cause dementia-like symptoms.
Researchers at Virginia Commonwealth University who analyzed data from 177,000 former military personnel diagnosed with dementia between 2009 and 2019 found that one in ten of them also showed signs of severe liver cirrhosis, or scarring of the organ.
They suggested that many of these may actually have been misdiagnosed and instead suffered from hepatic encephalitis (HE), or brain dysfunction that has symptoms similar to dementia.
The graph above shows how a healthy liver works (left) and what happens when the liver no longer functions properly (right). In these cases, toxic substances build up in the brain, which can cause dementia-like symptoms in a condition called hepatic encephalitis.
Unlike dementia, this can sometimes be reversed through medications, lifestyle changes, or, in severe cases, surgery to transplant a healthy liver into the body.
Researchers point to two previous cases in which dementia symptoms disappeared after treating the liver, and one woman said her husband was now a “different person.”
If scientists’ estimates are correct, 670,000 Americans may have been wrongly told they have dementia.
Liver cirrhosis is rarely detected in the early stages because it is a “silent” disease and symptoms are only seen when the damage is severe.
It can be caused by a variety of factors including prolonged alcohol abuse, ongoing viral infections (such as hepatitis), and obesity leading to fatty liver disease.
The chart above shows the location of the liver and what a healthy liver looks like compared to one with cirrhosis or liver scarring.
But the condition can lead to brain dysfunction, or HD, where patients begin to suffer from confusion, mood swings and impulsive behaviors, similar to patients with dementia.
While it is not common for liver damage of this degree to be completely reversed, it can improve by treating the underlying cause, such as alcohol dependence or obesity.
In more extreme cases, patients may also be offered a full liver transplant.
However, doctors noted that some cases of liver cirrhosis cause irreversible damage to blood vessels in the brain, leading to symptoms of dementia.
They also said that in some cases it was possible for both dementia (which can also be caused by “clumps” of beta amyloid in the brain) and liver cirrhosis to arise at the same time.
The graph above shows age-adjusted death rates from liver cirrhosis per 100,000 people. These have increased in recent years as an increase in dementia cases has also been reported.
Doctors say it’s difficult to distinguish patients who have HD from those who have dementia because there is no single blood test to separate them.
But in many cases patients are only screened for dementia, which is diagnosed by a battery of cognitive tests, but are not tested for liver cirrhosis.
Dr Jasmohan Bajaj, a gastroenterologist at Virginia Commonwealth University who led the research, told DailyMail.com: ‘What we think is that some people with dementia could have a reversible condition like HD.
‘Identification and treatment of HD (carried out with widely available medications) leads to improvements in mental function.
“So, if these 10 percent have HD that contributes to or masquerades as brain dysfunction due to dementia, then fixing the HD will help the mental dysfunction.”
He added: “We found this initially in two cases (revealed in 2022) where patients who had HD and were not diagnosed as such but were being treated for dementia improved after appropriate treatment for HD.”
Previous research has established a link between liver disease and an increased risk of dementia or Alzheimer’s disease.
But this paper is believed to be one of the first to suggest that such a large number of dementia patients may be misdiagnosed.
Previous research has also suggested that one in five patients diagnosed with Alzheimer’s disease may actually have a separate condition, such as brain atrophy, where an area of the brain loses neurons.
For the study, published in Open JAMA NetworkResearchers analyzed data from 177,000 veterans who were diagnosed with dementia between 2009 and 2019, but were not diagnosed with liver problems.
They then looked at each patient’s blood tests to determine if they had signs of liver cirrhosis.
This controls levels of fibrinogen, a protein produced by the liver, low levels of which indicate damage to the organ.
They found that up to 10 percent of patients had a score high enough (more than 2.67) to indicate potentially serious liver disease.
Of them, half scored above 3.25, further indicating the risk.
Researchers said the test could not diagnose liver cirrhosis, so more swabs were needed, but it was a key indicator of the disease.
None of the patients in the study had been tested for liver cirrhosis.
The patients were an average of 80 years old, mostly men, and had an average body mass index of 26, which placed them in the overweight range.
Explaining how the condition can be missed, said Dr. Lauren Beste, deputy director of general medicine at the VA Puget Sound Healthcare System. Statistical news: ‘It is not a condition that hurts. Patients do not come asking to be tested for cirrhosis.
“It’s easy to see why it could be missed, but it’s so important to make early diagnosis and save lives.”