Some dementia patients may have undiagnosed liver cirrhosis, study finds

RICHMOND, Va. (WRIC) – A new study suggests that some patients being treated for dementia could have an undiagnosed and treatable condition which is actually causing their symptoms.

According to researchers from the Virginia Commonwealth University's (VCU) School of Medicine and the Richmond Veterans Affairs (VA) Medical Center, around 10% of veterans diagnosed with dementia may instead suffer from hepatic encephalopathy (H.E.).

This study was a follow-up to a study which examined around 69,000 non-veteran patients diagnosed with dementia between 2009 and 2019 and found that around 13% may instead have H.E.

H.E. is a nervous system disorder brought on by cirrhosis, an advanced liver disease, similar to dementia. It occurs when the liver no longer filters toxins properly and they instead build up in the bloodstream and affect the brain.

This can cause confusion, disorientation and erratic behavior commonly associated with dementia. Prescription medications can help rid the body of toxins and reverse this condition, but without treatment, patients can go into a coma or die. 

Jasmohan Bajaj, M.D., a gastroenterologist with the VCU Stravitz-Sanyal Institute for Liver Disease and Metabolic Health and the Richmond VA Medical Center, discovered the brain dysfunction from two patients who were initially diagnosed with dementia, but it was later determined that they actually had H.E.

“They feel like they're a burden and they actually are not able to do any of the work that they used to do before," Bajaj said about H.E. patients. "They feel this loss of being themselves, similar to what many [dementia patients] feel.”

The researchers studied medical records of more than 175,000 U.S. Veterans who were diagnosed with dementia but not cirrhosis from VA hospitals across the country over a 10-year period, according to the study. 

Bajaj said his next focus is catching the liver disease in its early stages and finding better ways of differentiating between the two conditions, so that patients can have a proper diagnosis and treatment.

“It's very frustrating to take care of someone who is not getting better as a doctor, as a provider," Bajaj said. "It's in everyone's best interest that we actually come to the best diagnosis and as quickly as possible so we can relieve people of that burden.”