Dementia symptoms often occur along with hepatic encephalopathy (HE) in patients with cirrhosis of the liver, a recent study shows. «As patients with cirrhosis age, we encounter numerous individuals who may be susceptible to both diseases,» said lead author Dr. Jasmohan Bajaj, a professor of gastroenterology, hepatology and nutrition at Virginia Commonwealth University Medical Center in Richmond.»Given the prevalence of metabolic syndrome and alcohol consumption, you should rule out cirrhosis in your patients whose suspected diagnosis is dementia, as they may have concomitant HE,» he said. «Conversely, in patients with HE who predominantly have long-term memory problems and persistent cognitive changes, you should consult a neuropsychiatrist or neurologist to ensure that the underlying disease process is overcome,» Bajaj added. The study was publishedonline im American Journal of Gastroenterology.
HE is a common decompensating event in patients with cirrhosis. However, due to the aging population of cirrhosis patients, it is important to distinguish HE from non-hepatic causes of cognitive impairment, the authors note.Using data from the VA («Veteran Affairs») Corporate Data Warehouse, Bajaj and colleagues identified veterans with cirrhosis who received VA care between October 2019 and September 2021 and compared baseline characteristics between cohorts based on the presence or absence of dementia. The research team then assessed factors associated with a dementia diagnosis and adjusted for demographics, comorbidities, cirrhosis etiology, and cirrhosis complications.
The researchers identified 71,522 veterans with diagnostic codes for cirrhosis who were admitted to VA care in 2019. They were predominantly men (96.2%) and had an average age of 66 years. The most common causes of cirrhosis were hepatitis C, followed by nonalcoholic steatohepatitis (NASH). The group also included veterans with predominantly compensated cirrhosis and a median MELD-Na score of 9. The MELD-Na score measures the severity of chronic liver disease using values such as serum bilirubin, serum creatinine, and the international normalized ratio of prothrombin time and sodium to predict survival.
Among people with cirrhosis, 5,647 (7.9%) also had dementia diagnosis codes.This rate is higher than the prevalence of dementia in the general population and is consistent with the rate of dementia in veterans without cirrhosis older than 65 years, the authors note.
In general, veterans with dementia tended to be older, white, lived in an urban area, had higher MELD-Na scores, and were more likely to be diagnosed with alcohol-related cirrhosis, alcohol and tobacco use disorder, diabetes, chronic kidney disease, chronic heart failure, brain trauma, and cerebrovascular disease.
In a multivariable analysis, the presence of a decompensating event was significantly associated with dementia. However, in the subsequent analyses of the individual decompensating events, the strongest association was with HE, while ascites or variceal bleeding did not increase the risk.
When HE patients were defined as patients prescribed lactulose or rifaximin, the rate of patients with HE decreased from 13.7% to 10.9%. In an analysis with HE as a decompensating event, the association between HE and dementia remained significant compared to the definition of HE based on diagnostic codes alone.
This article was originally published on Medscape.com and translated by Dr. Petra Kittner.
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Source — https://www.univadis.de/viewarticle/%25C3%2584ltere-zirrhose-patienten-auf-der-suche-nach-der-demenz-2023a10005qo