Core Concepts
Patients diagnosed with dementia may actually have hepatic encephalopathy (HE) due to undiagnosed cirrhosis, which can be detected using the Fibrosis-4 (FIB-4) index.
Abstract
This study analyzed data from over 68,000 individuals diagnosed with dementia between 2009 and 2019. The key findings are:
- 12.8% of the dementia patients had a FIB-4 score > 2.67, and 7.6% had a score > 3.25, indicating the presence of advanced cirrhosis.
- Factors associated with a FIB-4 score > 3.25 included viral hepatitis, congestive heart failure, HIV, male gender, alcohol use disorder, and chronic kidney disease.
- The authors suggest that undiagnosed cirrhosis and potential hepatic encephalopathy (HE) can be a treatable cause or contributor to cognitive impairment in patients diagnosed with dementia.
- They recommend using the FIB-4 index as a screening tool to detect cirrhosis in patients with dementia, as this could lead to earlier diagnosis and treatment of the underlying liver condition.
- Incorporating the use of FIB-4 into screening guidelines, with input from various medical specialists, could help expand the diagnosis of cirrhosis and HE in dementia patients.
Stats
12.8% of dementia patients had a FIB-4 score > 2.67.
7.6% of dementia patients had a FIB-4 score > 3.25.
Factors associated with a FIB-4 score > 3.25 included viral hepatitis (OR 2.23), congestive heart failure (OR 1.73), HIV (OR 1.72), male gender (OR 1.42), alcohol use disorder (OR 1.39), and chronic kidney disease (OR 1.38).
Quotes
"We need to increase awareness that cirrhosis and related brain complications are common, silent, but treatable when found."
"Undiagnosed cirrhosis and potential hepatic encephalopathy can be a treatable cause of or contributor towards cognitive impairment in patients diagnosed with dementia."