ONE in 10 patients diagnosed with dementia may actually have a reversible liver condition, a study suggests.
US researchers studied veterans who were thought to have the memory robbing condition.
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But five to ten per cent in fact had hepatic encephalopathy (HE) – changes in the brain that occur in patients with serious liver disease – and not dementia.
The liver issue also causes issues with memory but can be treated and symptoms can be improved — unlike with dementia.
Dr Ashwin Dhana, a hepatologist at the University of Plymouth who was not involved in the research, said the study highlights the need for checking the livers of dementia patients.
Writing in The Conversation, he said: “Around 10 per cent of people diagnosed with dementia may instead have underlying silent liver disease with HE causing or contributing to the symptoms — an important diagnosis to make as HE is treatable.
“This study opens an important new avenue of research. It raises the awareness of checking for liver disease in people with general symptoms of dementia.
“This is likely to be a growing problem as the rates of both dementia and cirrhosis are increasing.”
Around 944,000 Brits are currently living with dementia and experts predict the numbers will exceed one million by the end of the decade.
Alzheimer’s disease is the most common form of the condition, and is thought to be caused by build-ups of proteins in the brain, including tau and amyloid.
There is currently no cure for the disease, although promising drugs to slow down its progress are currently in trials.
Hepatic encephalopathy is one of the major complications of cirrhosis — liver damage — and causes changes in the brain.
It can occur suddenly in people with acute liver failure but is more often seen in those with chronic liver disease.
If the liver becomes less able to filter out toxins in the blood when it becomes damaged, and some of these can reach the brain.
This can cause symptoms including confusion, forgetfulness and personality or mood changes — similar to some forms of dementia.
Undiagnosed cirrhosis could implicate HE as a contributor to overall cognitive impairment
Dr Jasmohan Bajaj
However, HE patients can be treated with laxatives to help remove ammonia and other toxins from the gut.
They may also be given an antibiotic called rifaximin to kill some of the ammonia-producing bacteria in the bowels.
In severe cases, patients may require a liver transplant.
The study, published in JAMA Network Open, looked at rates of the condition in 177,422 US veterans who had been previously diagnosed with dementia.
What are the symptoms of dementia?
Different types of dementia can affect people differently, and everyone will experience symptoms in their own way.
However, there are some common early symptoms that may appear some time before a diagnosis of dementia. These include:
- memory loss
- difficulty concentrating
- finding it hard to carry out familiar daily tasks, such as getting confused over the correct change when shopping
- struggling to follow a conversation or find the right word
- being confused about time and place
- mood changes
Source: The NHS
None had previously been diagnosed with cirrhosis.
Researchers looked at blood tests which helped produce a Fibrosis-4 score — an indicator of scarring on the liver, which occurs in cirrhosis.
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Lead author Dr Jasmohan Bajaj, of Virginia Commonwealth University, said around one in 10 had scores indicating HE was the cause of their symptoms.
He said: “Five to 10 per cent of the patients have laboratory values suggestive of possible undiagnosed cirrhosis that could implicate HE as a contributor to overall cognitive impairment.”
What are some of the different types of dementia?
Alzheimer’s disease
Alzheimer’s disease is the most common type of dementia.
It is a degenerative brain disease that is caused by complex brain changes following cell damage.
Experts still do not fully understand the disease’s exact cause.
But experts believe it probably happens when high levels of proteins get tangled up and surround brain cells, which leads to damage and cell death, this then causes communication between brain cells to slowly fade.
The brain cells in the hippocampus region of the brain are usually affected first.
This causes difficulty with remembering things because the hippocampus is the centre of learning and memory.
Alzheimer’s leads to dementia symptoms such as problems with short-term memory, difficulty paying bills or remembering appointments.
The symptoms worsen over time, as a person may lose the ability to speak or write properly, carry out daily tasks like getting dressed, or remember their relatives.
A person with Alzheimer’s can also become easily confused and aggressive and sometimes have outbursts of anger or violent behaviour.
Vascular dementia
Vascular dementia is the second most common type of dementia in the UK.
It occurs when the brain is damaged due to a lack of blood flow.
Sometimes people have both vascular dementia and Alzheimer’s, giving them a diagnosis of “mixed dementia”.
If the vascular system within the brain becomes damaged – so that the blood vessels leak or become blocked – then blood cannot reach the brain cells and they will eventually die.
This death of brain cells can cause problems with memory, thinking or reasoning, and when these cognitive problems are bad enough to impact on daily life, it is known as vascular dementia.
Dementia symptoms specific to vascular dementia include stroke-like symptoms, such as as muscle weakness, movement and thinking problems and mood changes, such as depression.
There are several different types of vascular dementia, due to the varying levels of damage on the affected part of the brain.
They include stroke-related dementia, single-infarct and multi-infarct dementia and subcortical vascular dementia