BTN News: Feeling confused, tired, or mentally foggy? It might not just be aging or early signs of dementia. For a growing number of people, these symptoms could signal a lesser-known but reversible condition: hepatic encephalopathy. Often overshadowed by more widely recognized neurological disorders like Alzheimer’s or Parkinson’s, hepatic encephalopathy is gaining attention as a silent but significant cause of cognitive decline. Recent studies suggest this condition may be far more prevalent than previously believed, particularly among individuals with undiagnosed liver disease. As obesity and metabolic diseases surge worldwide, the number of people at risk is expected to rise sharply in the coming years. Fortunately, the condition is not only identifiable but also treatable, offering hope for reversing symptoms and improving quality of life.
What is Hepatic Encephalopathy? A Silent Threat to Cognitive Health
Hepatic encephalopathy is a brain disorder caused by liver dysfunction. When the liver fails to filter toxins, like ammonia, from the blood, these substances accumulate and affect brain function, leading to symptoms such as confusion, sleep disturbances, and memory loss. Often misdiagnosed as dementia, this condition requires specific attention due to its reversible nature.
More Common Than We Think
A recent study published in The American Journal of Medicine reveals that hepatic encephalopathy may be more widespread than previously assumed. Researchers at Virginia Commonwealth University and the Veterans Affairs Medical Center in Richmond, USA, examined data from 68,807 patients diagnosed with dementia between 2009 and 2019. They found that 12.8% had signs of advanced liver disease, such as cirrhosis, suggesting a significant overlap between cognitive decline and liver dysfunction. These findings mirror earlier research where nearly 10% of 177,000 U.S. veterans displayed similar indicators of liver impairment.
Why the Confusion? Overlapping Symptoms with Dementia
Many patients initially diagnosed with dementia or Parkinson’s disease were later found to have liver-related cognitive issues. According to Dr. Jasmohan Bajaj, co-author of the study, the confusion arises because both conditions share symptoms like lethargy, confusion, and memory loss. Yet, unlike dementia, which progresses chronically, hepatic encephalopathy has a quicker onset and can often be reversed with proper treatment.
Recognizing the Signs: Is It Dementia or Hepatic Encephalopathy?
Dr. Sonia Brucki, from the Hospital of Clínicas in São Paulo, emphasizes the importance of differentiating between dementia and hepatic encephalopathy. Unlike dementia, which causes gradual cognitive decline, hepatic encephalopathy has a more rapid progression, often accompanied by specific signs such as sleep pattern changes, tremors, and loss of bladder control. However, milder cases may not show these obvious symptoms, making diagnosis challenging.
Subclinical Cases: The Diagnostic Challenge
The subtle, early stages of hepatic encephalopathy may be mistaken for other conditions, especially in cases where symptoms are mild, like occasional forgetfulness or confusion. “Patients may not exhibit tremors or reduced reflexes, which complicates the diagnosis,” Dr. Raymundo Paraná, a hepatologist from the Federal University of Bahia, explains. Standard cognitive assessments may miss these signs unless specific liver function tests are conducted.
The Role of the Liver: Why Hepatic Health Matters for the Brain
The liver plays a crucial role in detoxifying the body by metabolizing harmful substances. When it fails, these toxins, such as ammonia, bypass the liver and reach the brain, impairing cognitive functions. “In cases where blood flow to the liver is altered, toxins like ammonia end up in the brain, causing neurological symptoms,” Dr. Paraná states.
Reversing Cognitive Decline: How to Treat Hepatic Encephalopathy
Treating hepatic encephalopathy involves several approaches focused on reducing ammonia levels in the body. Preventing constipation, for example, is key because it limits the production of ammonia by gut bacteria. Specific laxatives, like lactulose, can promote regular bowel movements and create an intestinal environment less conducive to ammonia absorption.
Medications and Dietary Adjustments
If laxatives are not effective, doctors may prescribe antibiotics like rifaximin to control gut bacteria. Adjusting or replacing medications that affect liver function or promote ammonia production, such as certain diuretics, may also be necessary. Dietary changes, including a low-protein diet, can further support treatment by reducing ammonia production.
Preventing Misdiagnosis: The Importance of Early Detection
Given the high treatability of hepatic encephalopathy, early detection is crucial. Routine liver function tests (such as the FIB-4 test), electroencephalograms, and imaging studies should be standard when evaluating any form of cognitive impairment. This approach helps differentiate between hepatic encephalopathy and neurodegenerative diseases like Alzheimer’s.
Growing Concerns: An Increasingly Common Condition
The prevalence of hepatic encephalopathy is expected to rise due to several contributing factors: population aging, increased rates of obesity, metabolic syndrome, and other liver-damaging conditions. “Many liver diseases are silent until advanced stages,” warns Dr. Paraná. Regular check-ups, including blood tests and liver ultrasounds, are vital for early detection and intervention.
Conclusion: A Call for Greater Awareness and Proper Diagnosis
Understanding the link between liver health and cognitive function is critical to avoid misdiagnoses and ensure effective treatment. As conditions like hepatic encephalopathy become more common, especially with the rise of liver-affecting disorders, both patients and healthcare providers must remain vigilant. Timely diagnosis and targeted treatment can reverse cognitive decline, offering a better quality of life for those affected.
