Cognitive Issues and Liver Health: An Unexpected Connection
Suddenly, many individuals may experience fatigue, confusion, and extreme drowsiness, leading to concerns about brain health and potentially a diagnosis of dementia. However, a significant number of cases might be linked to a less-known condition: hepatic encephalopathy.
Experts are raising concerns about the lack of diagnosis for this condition and the anticipated rise in cases in the coming years due to increasing obesity and metabolic diseases.
Expanded Diagnosis
A recent study published in The American Journal of Medicine suggests that hepatic encephalopathy might be more prevalent than previously thought. Scientists from Virginia Commonwealth University and the Richmond Veterans Medical Center analyzed data from 68,807 patients diagnosed with dementia between 2009 and 2019. Health indicator results (FIB-4) revealed that 12.8% of these patients showed signs of cirrhosis, which could indicate hepatic encephalopathy.
Additionally, a parallel study involving 177,000 American veterans found that about 10% had liver dysfunction. Dr. Jasmohan Bajaj, a co-author of the study, noted, “FIB-4 is a simple method to assess the risk of advanced liver disease.” He also highlighted that “more than half of patients with cirrhosis develop some form of hepatic encephalopathy.”
Bajaj has observed cases where patients diagnosed with dementia were actually suffering from liver issues. After proper diagnosis and treatment, many neurological symptoms were fully resolved.
Understanding Hepatic Encephalopathy
Hepatic encephalopathy is caused by the brain being poisoned by substances that should be processed by the liver, which plays a vital role in digestion and toxin elimination. When the liver is not functioning correctly, compounds like ammonia can accumulate in the body and affect the brain, leading to impaired attention, reasoning, and memory.
Situations where blood flow to the liver is compromised can result in blood bypassing the liver and going directly to the brain.
Differentiating Conditions
Classic symptoms of hepatic encephalopathy may include lethargy, mental confusion, sleep disturbances, and tremors. Liver conditions often develop more rapidly compared to typical dementia, which tends to have a slower and more chronic progression.
Moreover, difficulty in identifying subclinical cases can lead to misdiagnoses, resulting in inappropriate treatments, such as those for Alzheimer’s disease.
Treatment Strategies
Although hepatic encephalopathy originates in the liver, cognitive rehabilitation can be enhanced through interventions targeting gut health. Ammonia, a substance usually metabolized by the liver, can cause brain issues due to its accumulation in the system.
A common approach to prevent ammonia from reaching the brain is managing constipation. The use of laxatives can help alleviate symptoms and prevent the growth of ammonia-producing bacteria.
If necessary, another medication, rifaximin, may be prescribed to control gut flora and reduce ammonia production. Additional measures include adjusting medications that may increase ammonia levels and adopting a low-protein diet.
These interventions have proven effective, and according to Bajaj, “most patients with hepatic encephalopathy respond well to treatment, making accurate diagnosis crucial.”
Future Considerations
With an aging population and rising chronic liver diseases, there is concern about a potential increase in hepatic encephalopathy cases. It is advised that individuals undergo regular check-ups, including blood tests and ultrasounds, to assess liver health and prevent future complications. “It is essential for everyone to be aware of the importance of maintaining liver health,” concludes Bajaj.
