Home Medizin Bei manchen Demenzfällen kann eine nicht diagnostizierte Leberzirrhose zugrunde liegen

Bei manchen Demenzfällen kann eine nicht diagnostizierte Leberzirrhose zugrunde liegen

von NFI Redaktion

New research indicates that cognitive impairments in some US veterans may be due to treatable hepatic encephalopathy (HE) rather than dementia.

According to the study by Jasmohan S. Bajaj, MD, from the Virginia Commonwealth University and the Richmond VA Medical Center, and colleagues, 5–10 % of veterans diagnosed with dementia may have undiagnosed cirrhosis, suggesting HE as a cause for cognitive impairments.

The research was partly inspired by a previous case study by Bajaj and colleagues, which showed that two elderly men diagnosed with dementia and Parkinson’s disease actually had HE, meaning that their symptoms were due to an advanced but treatable liver disease.

„After the correct diagnosis, everything that was considered dementia had disappeared,“ said Bajaj to Medscape Medical News. „One man’s spouse said, ‚My husband is now a different person.‘ It’s not that doctors don’t know how to treat HE; the problem was that they didn’t suspect it.“

Veterans with liver cirrhosis often have accompanying dementia and it is difficult to differentiate from HE, but the extent to which patients with dementia also have undiagnosed liver cirrhosis and HE is unknown, the authors of the current study write.

To investigate this, the researchers examined the prevalence and risk factors of undiagnosed cirrhosis – and hence potential HE – among US veterans.

The study was published online in JAMA Network Open.

Using the VHA Corporate Data Warehouse, researchers analyzed the medical records of 177,422 US veterans diagnosed with dementia but not liver cirrhosis between 2009 and 2019, who had sufficient laboratory results to calculate their Fibrosis-4 (FIB-4) score. The average age was 78.35 years, 97.1% were men, and 80.7% were white.

A FIB-4 score > 2.67 suggested advanced fibrosis, while a score > 3.25 indicated cirrhosis. Overall, 18,390 (10.3%) veterans had a FIB-4 score > 2.67 and 9,373 (5.3%) had a FIB-4 score > 3.25.

In multivariable logistic regression models, a FIB-4 score > 3.25 was associated with older age, male sex, heart failure, viral hepatitis, problematic drinking, and chronic kidney disease. On the other hand, a FIB-4 score > 3.25 was inversely associated with white race, diabetes, hyperlipidemia, stroke, tobacco use disorder, and rural residence.

In a subsequent validation study involving 89 veterans diagnosed with dementia in a single center, the researchers found similar results: 4.4–11.2% of participants had high FIB-4 scores, suggesting HE.

Further investigations revealed that 5% of the patients in this cohort had reasons other than cirrhosis for their high FIB-4 scores. The remaining patients (95%) showed evidence of cirrhosis, had risk factors, and/or had no other explanation for their high FIB-4 scores.

„The combination of high FIB-4 scores and other risk factors for liver disease in patients with dementia increases the possibility that reversible HE could be a factor associated with cognitive impairments,“ the authors wrote. „These results underscore the potential for improved cognitive function and quality of life through greater awareness of risk factors and diagnostic indicators of advanced liver disease, which can be linked with HE as a factor or differential diagnosis of dementia by doctors other than liver specialists.“

„A stronger awareness is important because unlike dementia, HE is very easy to treat,“ said Bajaj. „The biggest, simplest, and correctable cause is to find out if they have a severe liver disease. If that is the case, your friendly neighborhood gastroenterologist is waiting for you,“ he added.

The finding that 95% of the patients in the validation cohort had liver cirrhosis is „very impressive, as all patients with obvious cirrhosis had been excluded from consideration before FIB-4 was run,“ said William Carey, MD, deputy hepatology section head of the Department of Gastroenterology, Hepatology, and Nutrition at the Cleveland Clinic’s Digestive Disease Institute in Ohio. „This confirms that FIB-4 is a powerful case-finding tool for cirrhosis.“

„The ordering of a FIB-4 score ‚is within the purview of every healthcare provider,'“ said Carey, who was not involved in the study. „Patients with altered mental status, including suspected or confirmed dementia, should be evaluated for potential liver cirrhosis as their future treatment will change. Patients with elevated FIB-4 results should also be tested and treated for potential HE if present.“

„The study was partially funded by the VA Merit Review for Bajaj. He has received grants from Bausch, Grifols, Sequana, and Mallinckrodt outside of the submitted work. Carey reported no relevant disclosures.“

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