Undiagnosed liver disease frequently found among patients with cognitive impairment
Among 177,422 veterans with dementia and no prior cirrhosis diagnosis, 10.3% had a Fibrosis-4 score suggestive of advanced fibrosis and 5.3% had a score suggestive of cirrhosis.
Clinicians treating patients with dementia should screen for cirrhosis using the Fibrosis-4 (FIB-4) score to look for reversible factors associated with cognitive impairment, a recent cohort study indicated.
The retrospective cohort study used 2009 to 2019 data from the Veterans Health Administration (VHA). A total of 177,422 veterans with a diagnosis of dementia and no previous diagnosis of cirrhosis were included. FIB-4 scores greater than 2.67 were considered suggestive of advanced fibrosis and scores greater than 3.25 were suggestive of cirrhosis. Results were published by JAMA Network Open on Jan. 31.
The majority of veterans were male, 80.7% were White, and average age was 78.35 years. A total of 9,373 patients (5.3%) had a FIB-4 score above 3.25, and 18,390 (10.3%) had a score above 2.67. Similar percentages of patients with dementia in a validation cohort had high FIB-4 scores (4.4% and 11.2%).
A FIB-4 score greater than 3.25 was linked with older age (odds ratio [OR], 1.07; 95% CI, 1.06 to 1.09), male gender (OR, 1.43; 95% CI, 1.26 to 1.61), congestive heart failure (OR, 1.48; 95% CI, 1.43 to 1.54), viral hepatitis (OR, 1.79; 95% CI, 1.66 to 1.91), alcohol use disorder (OR, 1.56; 95% CI, 1.44 to 1.68), and chronic kidney disease (OR, 1.11; 95% CI, 1.04 to 1.17). FIB-4 was inversely associated with White race (OR, 0.79; 95% CI, 0.73 to 0.85), diabetes (OR, 0.78; 95% CI, 0.73 to 0.84), hyperlipidemia (OR, 0.84; 95% CI, 0.79 to 0.89), stroke (OR, 0.85; 95% CI, 0.79 to 0.91), tobacco use disorder (OR, 0.78; 95% CI, 0.70 to 0.87), and rural residence (OR, 0.92; 95% CI, 0.87 to 0.97). Similar associations were found with a FIB-4 score above 2.67.
"The combination of high FIB-4 scores and other risk factors for liver disease in patients with dementia raises the possibility that reversible [hepatic encephalopathy] could be a factor associated with cognitive impairment," the study authors wrote. Their findings should encourage clinicians caring for patients with dementia to diagnose cirrhosis as a possible factor linked with cognitive dysfunction, they added. "More work is needed to increase recognition of cirrhosis and optimize care for people with a known overlap between cirrhosis and dementia," the researchers concluded.