Is It Dementia or This Very Treatable Health Problem?

A diagnosis of dementia is devastating, but what if it’s wrong and the symptoms relate to another condition entirely? This tragic turn of events isn’t as uncommon as you might think.

Diagnosing dementia is not straightforward because the symptoms of confusion and memory loss can also be caused by vitamin deficiencies, thyroid problems, depression, the side effects of drugs, and other disorders that are largely reversible.

There’s now another condition to add to the list of those commonly misdiagnosed as dementia, and this one came as a surprise to doctors: liver disease.

Liver Disease is Often Silent

Your liver can be damaged in several ways. The damage, or scarring, is called fibrosis. Fibrosis can result from chronic hepatitis C infection, excessive drinking, or non-alcoholic fatty liver disease.

Aging also increases susceptibility to liver fibrosis. Left untreated, it can develop into cirrhosis, where the liver is severely scarred and permanently damaged.

Unfortunately, cirrhosis is a silent condition; symptoms appear only when it’s at an advanced stage and the liver starts to fail, so a substantial portion of advanced liver disease cases remains undiagnosed.1 And this spells bad news for your memory…

Toxins Travel to The Brain

One of the liver's functions is to remove toxins from the blood. However, this function can’t be carried out effectively when the liver is damaged by fibrosis.

Toxins are now able to travel to the brain, causing agitation, confusion, disorientation, and memory problems that can mimic dementia. The condition is called hepatic encephalopathy (HE).

Jasmohan Bajaj, M.D., a world-renowned expert in HE at Virginia Commonwealth University and Richmond VA Medical Center, was alerted to the possibility this could be mistaken for dementia by two patients, one diagnosed with dementia and the other with Parkinson’s disease. And these are not isolated cases…

One in Ten Could be Misdiagnosed

When Dr. Bajaj treated these patients for HE using a medicine that clears toxins from the blood, their neurological symptoms dramatically improved; one could even resume driving. Dr. Bajaj continued his research with a trial published in 2023 that identified 71,552 U.S. veterans with cirrhosis. The findings revealed a significant overlap between the two conditions: HE and dementia.2

For the new study, Dr Bajaj wanted to look at the flip side to discover what percentage of veterans diagnosed with dementia also had a raised marker for liver disease. To find out, he and his team analyzed medical records of 177,422 veterans diagnosed with dementia but not cirrhosis. Their average age was 78, and all had a test called FIB-4, which screens specifically for liver fibrosis.3

The analysis, published in JAMA Network Open in January, revealed that 10.3 percent had an FIB-4 score greater than 2.67, suggestive of advanced fibrosis, and 5.3 percent had a score greater than 3.25, suggestive of cirrhosis.

High FIB-4 scores were more common in men, heavy drinkers, people of older age, and patients with congestive heart failure or viral hepatitis. High FIB-4 scores were less likely in folks who were white, had a rural residence, smoked, had high blood fats, or had experienced stroke, diabetes, or kidney disease.

Dr. Bajaj and his team validated their findings on two other sets of dementia patients at their medical center. This revealed similar results, with 11.2 percent having high FIB-4 scores.

What does this mean for you? If you or someone you love is suffering from a change in memory function or experiencing confusion, a special screening for liver disease is in order.

Dementia Patients Should be Screened

Based on these findings, Dr. Bajaj and his team believe clinicians encountering patients with dementia should screen for cirrhosis using FIB-4 scores to see if HE is responsible for their symptoms.

This is important because routine blood work relies on commonly tested liver enzymes, AST and ALT, which science shows are not useful for detecting liver disease alone. Even patients with advanced liver disease often have normal lab values!

Commenting on the research, Dr. Bajaj said the “unexpected link between dementia and liver health emphasizes the importance of screening patients for potentially treatable contributors to cognitive decline.

“Early detection of liver issues allows for targeted interventions. Routinely using the FIB-4 index to evaluate dementia could help a significant number of patients, families, and physicians by providing an opportunity to treat and potentially reverse cognitive impairment brought on by liver disease.”

What Can You Do About Liver Fibrosis?

Fortunately, liver fibrosis can be treated. Usually, doctors begin by addressing the root cause, such as viral hepatitis, alcohol abuse, or non-alcoholic fatty liver disease (NAFLD). This may involve antiviral drugs, abstaining from alcohol, or managing metabolic conditions like diabetes and obesity.4

Regarding medications, there are currently no approved drugs to help alleviate fibrosis, but there are natural treatments. Antioxidants like vitamin E and silymarin from milk thistle are proven to help the liver repair and regenerate itself. The most important part of treatment is lifestyle change. These include dietary changes, increased physical activity, and weight loss, which can help slow or reverse fibrosis, especially in cases of NAFLD.5

The key is to detect and treat liver fibrosis early, as the damage can often be reversed at this stage. However, once fibrosis progresses to cirrhosis, the damage can become irreversible.