A Possible Reversible Cause of Cognitive Impairment: Undiagnosed Cirrhosis and Potential Hepatic Encephalopathy in Patients with Dementia - 24/10/24
Abstract |
Background |
Dementia and hepatic encephalopathy (HE) have symptom overlap and are challenging to differentiate. The presence of undiagnosed cirrhosis may lead to missed opportunities to treat HE, which was found in a veterans database. This needs validation in a non-veteran cohort.
Methods |
A retrospective cohort study was conducted between 2009 and 2019 using national non-Veteran patient data from the multi-center TriNetX database. Participants included 68,807 patients with a dementia diagnosis at ≥2 visits, no prior diagnosis of cirrhosis, and with sufficient laboratory test results to calculate the Fibrosis-4 (FIB-4) index, which indicates liver disease. Prevalences of high FIB-4 scores (>2.67 and >3.25) were measured within the cohort, and associations between high FIB-4 and comorbidities/demographics were examined.
Results |
Within the cohort (44.7% male, 78.0% White, mean age 72.73 years (±11.09), 7.6% (n = 5815) had a FIB-4 index > 3.25 and 12.8% (n = 8683) had FIB-4 > 2.67. In multivariable logistic regression models, FIB-4 > 3.25 was associated with male gender (OR: 1.42 [1.33-1.51]), congestive heart failure (OR: 1.73 [1.59-1.87]), viral hepatitis (OR: 2.23 [1.84-2.68]), alcohol use disorder (OR: 1.39 [1.22-1.58]), and chronic kidney disease (OR: 1.38 [1.28-1.48]), and inversely associated with White race (OR: 0.76 [0.71-0.82]) and diabetes (OR: 0.82 [0.77-0.88]). Similar findings were associated with the FIB-4 > 2.67 threshold.
Conclusion |
The findings of this national cohort suggest that the FIB-4 index could be utilized to screen for potential undiagnosed cirrhosis in patients with dementia, and that hepatic encephalopathy might be misdiagnosed as dementia or cause worsening of cognitive function in patients with dementia.
Le texte complet de cet article est disponible en PDF.Keywords : Alcohol use disorder, Alzheimer's, Cirrhosis, Hepatic encephalopathy, Viral hepatitis
Plan
| Funding: This work was partly supported by 2I01CX001076 and 101CX002472 VA merit review and NIH NCATS 29569016. |
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| Authorship: All authors had access to the data; SS and JSB wrote the initial draft and all others were involved in critical revisions. SS: Writing – review & editing, Methodology, Investigation, Formal analysis. RKS: Writing – review & editing, Validation, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. EF: Methodology, Formal analysis, Data curation, Conceptualization. MG: Writing – review & editing, Supervision, Investigation. AG: Writing – review & editing, Validation, Methodology. NP: Writing – review & editing, Visualization, Supervision. JSB: Writing – original draft, Visualization, Supervision, Formal analysis, Data curation. |
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| Conflict of Interest: No conflicts of interest for any author. |
Vol 137 - N° 11
P. 1082 - novembre 2024 Retour au numéro
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