In the medical world, it’s no secret that misdiagnoses happen. But these misdiagnoses can be costly; patients may miss out on earlier treatment and prevention, and misdiagnosis may correlate with worse outcomes. According to an article from Marcus A. Banks in Gastroenterology & Endoscopy News, a study presented at the 2022 Digestive Diseases Week and the International Liver Congress explored the prevalence of misdiagnosis in relation to hepatic encephalopathy. The study found a strong association between hepatic encephalopathy and dementia in United States veterans with liver cirrhosis.
The Research
In particular, the study sought to understand whether certain veterans had dementia – or whether hepatic encephalopathy was being overlooked and misdiagnosed as dementia. The researcher sourced data from 71,552 veterans over a two-year period. All participants were diagnosed with cirrhosis. Approximately 10% of veterans under 65 years old were also diagnosed with dementia, compared to 12.4% of those aged 65 or older. Findings from the study show that:
- Having hepatic encephalopathy was a cirrhosis-related complication that was positively associated with a dementia diagnosis.
- Alternately, negative associations existed between dementia and other cirrhosis-related complications such as variceal bleeding, hepatorenal syndrome, spontaneous bacterial peritonitis, and ascites (the accumulation of fluid in the peritoneal cavity).
- Alcohol-related cirrhosis, alcohol use disorder, and hepatitis B were all found to be associated with dementia. Chronic kidney disease (CKD), chronic heart failure, and cerebrovascular disease were not.
One researcher hypothesizes that nonalcoholic steatohepatitis (NASH) is under-researched and under-diagnosed. If NASH causes cirrhosis but isn’t caught, someone might receive a dementia diagnosis rather than hepatic encephalopathy.
The researcher also suggests that more strategies and analyses are needed to delineate between dementia and hepatic encephalopathy.
What is Hepatic Encephalopathy?
Hepatic encephalopathy is a rare condition causing the deterioration of brain function in some individuals with liver disease. 24-53% of people with portosystemic shunts, and 70% of those with liver cirrhosis, will develop hepatic encephalopathy. It occurs when toxins, which are normally cleared from the body through the liver, begin accumulating in the blood and may travel to the brain.
This is a complex and variable disorder, with some experiencing almost no symptoms and others experiencing debilitating or life-threatening complications. Episodes may be triggered by gastrointestinal bleeding, certain drugs, infections, dehydration, and low oxygen levels, among others. Symptoms and manifestations can (but do not always) include:
- Forgetfulness and/or confusion
- Fatigue and lethargy
- Problems with balance and coordination
- Shortened attention span
- Sleep disruptions
- Changes in mood, behavior, and personality
- Brain swelling
- Intracranial hypertension
- Disorientation
- A sudden lack of restraint and/or inappropriate behavior
- Changes in memory and/or concentration
- Decreased alertness
- Slurred speech
- Skill regression
- Coma
- Sepsis (complication)
- Kidney and respiratory abnormalities (complication)
