Hundreds of thousands of Americans with dementia (and millions worldwide) may actually have a very treatable liver condition, a study suggests.
Researchers found that 10 percent of U.S. veterans diagnosed with dementia did not actually have hepatic encephalopathy (HE), severe scarring of the liver that can cause cognitive problems similar to Alzheimer’s.
When damage continues over a long period of time, the liver is unable to detoxify the blood, allowing toxins to build up and reach the brain.
HD can be very mild and difficult to diagnose (for example, not all patients with cirrhosis have it) and symptoms can be as subtle as changes in sleep pattern or irritability.
But once diagnosed, it can be treated with common medications. This is usually done with laxatives that help eliminate ammonia and other toxins that build up in the intestine, followed by antibiotics that kill some of the harmful bacteria that produce ammonia in the intestine.
The graph above shows Alzheimer’s rates per 100,000 people, both age-standardized and for all ages. Age-standardized is a method used to adjust for differences in age distribution between populations or over time, while non-age-standardized is the crude rate calculated across all age groups of the population without any adjustment.
A recent study of American veterans found that 10% of those diagnosed with dementia actually had a liver condition called hepatic encephalopathy (HE), a treatable condition.
Dementia, on the other hand, is a condition caused by long-term damage to brain cells and function.
In the case of vascular dementia, it is caused by a lack of blood flow to the brain due to damage to small blood vessels due to diabetes or high blood pressure.
Alzheimer’s, the most common form of dementia, occurs when plaques build up in the brain and degrade a person’s memory and other cognitive abilities.
Although there are some medications that modestly slow the progression of dementia, it is incurable.
Dr Jasmohan Bajaj, lead author of the new study, said: “This unexpected link between dementia and liver health emphasizes the importance of screening patients for potentially treatable factors that contribute to cognitive decline.”
“Early detection of liver problems allows for targeted interventions and opens avenues to address treatable factors that contribute to cognitive decline.”
More than 100 million Americans have some type of liver disease, including about 80 million with fatty liver disease and don’t know it. Meanwhile, more than eight million Americans suffer from dementia.
Cases of liver disease have increased over the past two decades, according to a study that looked at rates of the condition among members of the military.
In the new study, Veterans Health Administration doctors studied more than 177,000 veterans who were diagnosed with dementia in two clinic visits between 2009 and 2019. About 30 percent of them had liver disease .
They looked at the group’s blood results and used them to calculate their Fibrosis-4 (FIB-4) scores, a score based on liver blood results and age, which predicts liver damage.
More than 175,000 people were included in the analysis. Of them, 10 percent had a FIB-4 score greater than 3.25, the cutoff for diagnosing liver scarring.
A high score was less likely in people who had diabetes, high blood pressure or kidney disease, all risk factors for dementia.
But a high FIB-4 score was more common in those with viral hepatitis and heavy alcohol users, which are major risk factors for liver disease.
This suggests that people with a high FIB-4 score may actually have liver disease and HD causes their symptoms rather than dementia, the authors said.
If the liver becomes scarred, it loses its ability to do its job: eliminate toxins that have a poisoning effect on brain cells.
When this causes HD, a patient is likely to experience a number of changes that mirror those caused by dementia, including cognitive impairment and impaired motor skills, as well as sleep and mood problems.
HD occurs in the brains of approximately 50 percent of people with cirrhosis, resulting from the toxic effect that toxins such as ammonia and manganese have on brain cells.
Deceased due to cirrhosis are on the riseand cases have increased in the last two decades, according to a study that looked at the condition rates among members of the army.
At the same time, rates of Alzheimer’s and other dementias have steadily increased since approximately 2000, and are expected to continue increasing.
The study had some important caveats. Ninety-seven percent of the study subjects were men and 80 percent of them were white, although the majority of dementia patients are women, Hispanic or black.
It is also possible that there was too much reliance on the FIB-4 score, which does not provide conclusive evidence of liver disease.
Their study was published in the journal. Open JAMA Network.
The liver can be damaged in a variety of ways, including fatty deposits, alcohol consumption, and viruses; Hepatitis is the most common type of liver disease.
When damage continues over a long period of time, scarring may occur and at a certain point the liver is unable to detoxify the blood. These toxins can accumulate and reach the brain, causing HD.
HD can be fatal, although it can be treated with laxatives to remove ammonia and other toxins that build up in the intestine, followed by an antibiotic that kills harmful bacteria.