A significant number of patients diagnosed with dementia may have had undiagnosed cirrhosis and potential hepatic encephalopathy, according to the results of a new study.
The retrospective cohort study, published in the American Journal of Medicine, conducted between 2009 and 2019, analyzed data from 68,807 patients with dementia diagnoses using the multi-center TriNetX database. Researchers used the Fibrosis-4 (FIB-4) index to identify potential undiagnosed cirrhosis.
Key findings:
- Patient demographics: 44.7% male, 78.0% white, mean age 72.73 years (±11.09)
- FIB-4 index >3.25: 7.6% (n = 5815)
- FIB-4 index >2.67: 12.8% (n = 8683)
Multivariable logistic regression models revealed the following associations with FIB-4 > 3.25:
- 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])
- Chronic kidney disease (OR: 1.38 [1.28–1.48])
White race (OR: 0.76 [0.71–0.82]) and diabetes (OR: 0.82 [0.77–0.88]) were inversely associated with higher FIB-4 scores. Similar findings were associated with the FIB-4 > 2.67 threshold.
Methods: The study included patients with a dementia diagnosis at 2 or more visits, no prior diagnosis of cirrhosis, and sufficient laboratory test results. Prevalences of high FIB-4 scores (>2.67 and >3.25) were measured, and associations between high FIB-4 and comorbidities and demographics were examined.
The study concluded that the FIB-4 index could be utilized to screen for potential undiagnosed cirrhosis in patients with dementia. The authors suggested that hepatic encephalopathy might be misdiagnosed as dementia or cause worsening of cognitive function in patients with dementia.
This study validated previous findings from a Veterans database in a non-Veteran cohort, addressing the challenging differentiation between dementia and hepatic encephalopathy due to symptom overlap.
Conflict of interest disclosures were not made available at time of publishing.