Veterans in whom dementia is diagnosed may not have a lifelong disease at all. Instead, they may have a reversible cognitive decline caused by advanced liver disease, according to a study published Wednesday in JAMA Network Open.

Doctors can have a tough time telling the difference between dementia and cognitive decline caused by cirrhosis (called hepatic encephalopathy). The cognitive decline from cirrhosis can be reversed unlike that of dementia, so people with hepatic encephalopathy could be treated.

Cirrhosis is an advanced form of liver disease that results in liver scarring and buildup of toxins in the blood. The toxins can move to the brain, causing confusion and delirium. Medicines are available to get rid of the toxins and reverse the brain-related symptoms, so long as the right diagnosis is made.

“This unexpected link between dementia and liver health emphasizes the importance of screening patients for potentially treatable contributors to cognitive decline,” Jasmohan Bajaj, MD, lead author and a gastroenterologist with the Virginia Commonwealth University Stravitz-Sanyal Institute for Liver Disease and Metabolic Health and the Richmond VA Medical Center, said in a statement.

The researchers say their findings should apply to people who weren’t veterans, as they only studied US veterans. 

As part of the study, the team looked at data from 177,422 veterans in whom dementia but not cirrhosis was diagnosed between 2009 and 2019. Most of the participants were mal,e and the average age was 78.

The team evaluated participants’ Fibrosis-4, or FIB-4, scores — an initial screening for liver disease. The investigators found that 10.3% of veterans with dementia had high FIB-4 scores, so they most likely had cirrhosis that could account for the cognitive decline. 

The team conducted a follow-up study at the Richmond VA Medical Center and saw similar results. As many as 11.2% of the patients there had high FIB-4 scores. 

Last year, Bajaj published a report about a link between dementia and cirrhosis. He cited cases of two older men who doctors thought had dementia and Parkinson’s disease. The men’s health improved after they were treated for hepatic encephalopathy. This experience sparked Bajaj to undertake the newer study.

Bajaj said that clinicians should incorporate liver assessments into patient visits, especially if they see people living with dementia. 

“Early detection of liver issues allows for targeted interventions and opens avenues for addressing treatable factors contributing to cognitive decline,” he said.