More than one in ten people diagnosed with dementia may instead have a common, treatable liver condition that causes similar symptoms, say experts.
It means thousands may have been wrongly told they have the incurable memory-robbing disease — when in fact their problems are reversible, they add.
A study of more than 68,000 people diagnosed with dementia found that almost 13 per cent has signs of brain ‘poisoning’ known as hepatic encephalopathy (HE).
This is triggered by liver cirrhosis — when scar tissue builds up in the organ, usually as a result of heavy drinking, obesity or the viral infection hepatitis.
The new findings back up research published in February that showed about 10 per cent of US veterans with dementia could in fact have HE.
Speaking to MailOnline, Dr Rob Howard, Professor of Old Age Psychiatry at University College London said: ‘No one should be diagnosed with dementia without physical causes for their confusion being excluded’
Early symptoms of hepatic encephalopathy include confusion, forgetfulness, personality or mood changes, changes in sleep patterns and difficulty writing — which are also dementia symptoms
Yet British dementia specialists cast doubt on the suggestion, saying there are in fact subtle differences between HE and dementia that doctors would spot.
Liver cirrhosis affects roughly 18 per cent of men and 11 per cent of women in the UK and causes fatigue, nausea, swollen limbs and itchy skin.
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As the scarring stops the liver from filtering toxins out of the blood as it should, they build up and can affect the brain, leading to hepatic encephalopathy.
Early symptoms include confusion, forgetfulness, personality or mood changes, changes in sleep patterns and difficulty writing — which are also dementia symptoms.
As it advances, it can also cause unusual or slow movements, shaky hands and arms, extreme anxiety and severe confusion, jumbled or slurred speech and seizures.
However unlike dementia, which only gets worse over time, hepatic encephalopathy can be completely reversed with the right treatment.
This includes specific antibiotics and nutritional supplements.
The study’s author, Virginia-based gastroenterologist Dr Jasmohan Bajaj said: ‘We need to increase awareness that cirrhosis and related brain complications are common, silent, but treatable when found.
‘With the aging population, the potential for overlap between hepatic encephalopathy and dementia has risen and should be considered.’
He added: ‘Undiagnosed cirrhosis and potential hepatic encephalopathy can be a treatable cause of or contributor towards cognitive impairment in patients diagnosed with dementia.’
Liver cirrhosis also increases the risk of liver cancer, which is another important reason it should be picked up, said Dr Baja.
A recent report found that around one million people in the UK have a form of dementia. This is projected to rise to 1.4 million people by 2040.
In the US, the Centers for Disease Control estimate Current estimates 5.8 million Americans have Alzheimer’s disease and related dementias, with the vast majority over the age of 65.
In the new study Dr Baja and colleagues analysed data from 72 US healthcare providers on 68,807 patients, mostly in their early 70s, who were diagnosed with dementia between 2009 and 2019.
None had a prior cirrhosis diagnosis. The team looked at results of blood tests for levels of certain compounds to help them calculate a Fibrosis-4, or FIB-4 score — a common test for cirrhosis.
Commenting on the research for Medscape Medical News, liver specialist Dr Nancy Reau at Rush University Medical Center in Chicago, said doctors may not realise that liver disease leads to cognitive decline.
‘Using easy tools like FIB-4 can make sure you don’t miss liver disease as a contributing factor in a patient that presents with neurocognitive symptoms.’
However speaking to MailOnline, Dr Rob Howard, Professor of Old Age Psychiatry at University College London said: ‘Full-blown hepatic encephalopathy looks different to dementia.
‘The symptoms of hepatic encephalopathy fluctuate in a way that Alzheimer’s doesn’t and anyone working in a memory clinic will be familiar with that.
‘No one should be diagnosed with dementia without physical causes for their confusion being excluded.
‘Simple tests should always be done and these include a liver function test.
‘But I don’t think it’s credible to say people with dementia have been misdiagnosed, based on this evidence.’
Rachel Carter is a health and wellness expert dedicated to helping readers lead healthier lives. With a background in nutrition, she offers evidence-based advice on fitness, nutrition, and mental well-being.
