Hepatic Encephalopathy Associated With Dementia Onset in Veterans With Cirrhosis

Hepatic encephalopathy (HE) correlated with the development of dementia in almost 8% of US veterans with cirrhosis, according to study findings published in the American Journal of Gastroenterology.

Researchers conducted a cohort study to assess baseline characteristics of patients with cirrhosis and to determine which characteristics correlated with onset of dementia. Researchers identified 71,552 veterans with either 1 inpatient or 2 outpatient diagnoses of cirrhosis via International Classification of Diseases (ICD)-10 codes using the VA Corporate Data Warehouse.

Of the 71,552 veterans with cirrhosis, 5647 (7.89%) developed dementia. The researchers noted that veterans with cirrhosis and dementia tended to be older, often lived in cities, were more commonly White, and had comorbidities including metabolic syndrome, brain trauma, cerebrovascular disease, diabetes, chronic kidney disease, and alcohol-related cirrhosis.

When assessing each of the characteristics independently, factors such as homelessness, older age, Hispanic ethnicity, alcohol and tobacco use, higher comorbidity scores, and residence in the Midwest or South all positively correlated with onset of dementia.

Any type of decompensating event for cirrhosis correlated strongly with onset of dementia; however, when analyzing decompensating events individually, the researchers found that only HE, not ascites, correlated with a diagnosis of dementia, independently from other risk factors such as brain injury, older age, metabolic syndrome, and alcohol use.

In contrast, the comorbidities of hepatitis C viral (HCV) infection and nonalcoholic steatohepatitis (NASH) correlated with a lower risk of developing dementia, even though HCV, NASH, and alcohol-related cirrhosis all impact the brain directly.

“Dementia is commonly diagnosed in patients with cirrhosis and correlates with a diagnosis of HE,” the study authors wrote. “Increased awareness of the overlap between dementia and HE, as well as reliable diagnostic and treatment strategies, is needed for the aging population of veterans with cirrhosis.”

Study limitations include results based on diagnostic codes rather than neuropsychological testing or other gold standard testing, potential underdiagnosis or misdiagnosis in this cohort (either for dementia or HE), lack of generalizability of results outside of the predominantly male veteran population, and lack of differentiation between the different types of dementia.

This article originally appeared on Gastroenterology Advisor