Treatable diseases misdiagnosed as dementia in 13% of cases

As the population ages, more and more people are experiencing memory and thinking problems. This problem affects many individuals and their families. Every year, more than 10 million new cases of dementia are reported worldwide.

However, a recent study in the United States found that about 13% of people diagnosed with dementia may not actually have the disease. These people may have a treatable condition but are not receiving proper treatment due to a misdiagnosis.

“Health care providers need to be aware of this potential overlap between dementia and hepatic encephalopathy, which is treatable,” says Jasmohan Bajaj, a liver specialist at Virginia Commonwealth University.

Overlap between dementia and hepatic encephalopathy

Hepatic encephalopathy is a brain disease caused by liver failure. It affects more than 40% of people with end-stage liver disease, also called cirrhosis. The mental disorders it causes are often confused with dementia.

The liver has many important functions. It controls the levels of most chemicals in our body, filters the blood, and helps with digestion.

In addition to the well-known damage caused by alcohol, the liver is also at risk from the hepatitis virus, high cholesterol, obesity, diabetes, stress, and aging. However, if detected early and treated properly, liver damage can be reversed.

Many of these risks can be reduced through diet and lifestyle changes. In addition, new drug treatments are being developed. In fact, treatment for hepatic encephalopathy has improved cognitive problems in at least two patients who were initially diagnosed with dementia.

“He’s a different person!” exclaims one patient’s wife, noting that his memory loss, falls, tremors and hallucinations have all disappeared.

The impact of aging on the liver could be reversible

A recent study in mice suggests that the effects of aging on the liver may be reversible if treated early.

“We’ve shown that aging worsens nonalcoholic liver disease … and by reducing that impact, we can reverse the damage,” says Anna Mae, a hepatologist at Duke University. “You’re never too old to heal.”

Earlier this year, Bajaj and his team reviewed the medical records of 177,422 U.S. veterans diagnosed with dementia between 2009 and 2019. None had been diagnosed with liver disease, but more than 10% had elevated fibrosis 4 (FIB-4) scores, indicating probable cirrhosis (end-stage liver disease).

In their latest study, Scott Silvey, a biostatistician at Virginia Commonwealth University, teamed up with Bajaj and others to examine 68,807 medical records from a national database of nonveterans. They wanted to see if their previous findings about veterans applied to the U.S. population as a whole.

Surprisingly, they found that nearly 13% of these patients had high FIB-4 scores, indicating a high likelihood of cirrhosis.