Dementia Frequently Coexists With Hepatic Encephalopathy but Not Other Cirrhosis Complications in US Veterans.
Journal
The American journal of gastroenterology
ISSN: 1572-0241
Titre abrégé: Am J Gastroenterol
Pays: United States
ID NLM: 0421030
Informations de publication
Date de publication:
01 03 2023
01 03 2023
Historique:
received:
20
08
2022
accepted:
10
01
2023
pubmed:
18
1
2023
medline:
7
3
2023
entrez:
17
1
2023
Statut:
ppublish
Résumé
Hepatic encephalopathy (HE) is a common decompensating event in patients with cirrhosis. Because of the aging population of patients with cirrhosis, differentiating HE from nonhepatic etiologies of cognitive impairment, such as dementia, is increasingly important. Veterans with cirrhosis were identified via International Classification of Diseases -10 codes between October 1, 2019, and September 30, 2021, using the VA Corporate Data Warehouse. Baseline characteristics were compared between cohorts based on the presence vs absence of dementia. Factors associated with having a diagnosis of dementia were evaluated using multivariate logistic regression models, adjusting for demographics, comorbid illnesses, cirrhosis etiology, and cirrhosis complications. A total of 71,552 veterans with cirrhosis were identified, of which, 5,647 (7.89%) veterans had a diagnosis of dementia. Veterans with dementia were older, more frequently White, urban located, and diagnosed with alcohol-related cirrhosis, metabolic syndrome, brain trauma, and cerebrovascular disease more frequently. On multivariable analysis, the presence of any decompensating event was associated with dementia. Multivariable analysis of individual decompensating events revealed HE to be associated with a dementia diagnosis, but not ascites, independent of other risk factors analyzed. Dementia is commonly diagnosed in patients with cirrhosis and correlates with a diagnosis of HE, independent of alcohol use, brain injury, age, and other metabolic risk factors. Dementia did not correlate with other decompensating events. 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.
Identifiants
pubmed: 36649134
doi: 10.14309/ajg.0000000000002189
pii: 00000434-202303000-00026
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
475-480Informations de copyright
Copyright © 2023 by The American College of Gastroenterology.
Références
Beste LA, Leipertz SL, Green PK, et al. Trends in burden of cirrhosis and hepatocellular carcinoma by underlying liver disease in US veterans, 2001-2013. Gastroenterology 2015;149(6):1471–82.e5.
Kaplan DE, Chapko MK, Mehta R, et al. Healthcare costs related to treatment of hepatocellular carcinoma among veterans with cirrhosis in the United States. Clin Gastroenterol Hepatol 2018;16(1):106–14.e5.
Orman ES, Roberts A, Ghabril M, et al. Trends in characteristics, mortality, and other outcomes of patients with newly diagnosed cirrhosis. JAMA Netw Open 2019;2(6):e196412.
Hirode G, Saab S, Wong RJ. Trends in the burden of chronic liver disease among hospitalized US adults. JAMA Netw Open 2020;3(4):e201997.
Xiao T, van Kleef L, Ikram MK, et al. Association of nonalcoholic fatty liver disease and fibrosis with incident dementia and cognition: The Rotterdam study. Neurology 2022;99(6):e565–73.
Parikh NS, Kamel H, Zhang C, et al. Association between liver fibrosis and incident dementia in the UK Biobank study. Eur J Neurol 2022;29(9):2622–30.
Bajaj JS, Wade JB, Gibson DP, et al. The multi-dimensional burden of cirrhosis and hepatic encephalopathy on patients and caregivers. Am J Gastroenterol 2011;106(9):1646–53.
Plassman BL, Langa KM, Fisher GG, et al. Prevalence of dementia in the United States: The aging, demographics, and memory study. Neuroepidemiology 2007;29(1-2):125–32.
GBD 2019 Dementia Forecasting Collaborators. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: An analysis for the global burden of disease study 2019. Lancet Public Health 2022;7(2):e105–e125.
Krishnan LL, Petersen NJ, Snow AL, et al. Prevalence of dementia among Veterans Affairs medical care system users. Dement Geriatr Cogn Disord 2005;20(4):245–53.
Bajaj JS, Schubert CM, Heuman DM, et al. Persistence of cognitive impairment after resolution of overt hepatic encephalopathy. Gastroenterology 2010;138(7):2332–40.
Bajaj JS, Duarte-Rojo A, Xie JJ, et al. Minimal hepatic encephalopathy and mild cognitive impairment worsen quality of life in elderly patients with cirrhosis. Clin Gastroenterol Hepatol 2020;18(13):3008–16.e2.
Bajaj JS, Ahluwalia V, Steinberg JL, et al. Elderly patients have an altered gut-brain axis regardless of the presence of cirrhosis. Sci Rep 2016;6(1):38481.
Vilstrup H, Amodio P, Bajaj J, et al. Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the American Association for the Study of Liver Diseases and the European Association For the Study of the Liver. Hepatology 2014;60(2):715–35.
Bajaj JS, Gentili A, Wade JB, et al. Specific challenges in geriatric cirrhosis and hepatic encephalopathy. Clin Gastroenterol Hepatol 2022;20(8):S20–S29.
Rogal S, Youk A, Zhang H, et al. Impact of alcohol use disorder treatment on clinical outcomes among patients with cirrhosis. Hepatology 2020;71(6):2080–92.
Bajaj JS, Ratliff SM, Heuman DM, et al. Proton pump inhibitors are associated with a high rate of serious infections in veterans with decompensated cirrhosis. Aliment Pharmacol Ther 2012;36(9):866–74.
Kodishala C, Hulshizer CA, Kronzer VL, et al. Risk factors for dementia in patients with incident rheumatoid arthritis: A population-based cohort study. J Rheumatol 2022;50(1):48–55.
Roderburg C, Loosen SH, Jordens MS, et al. Heart failure and dementia: A comparative analysis with different types of cancer. Eur Heart J Open 2021;1:oeab003.
Maclagan LC, Wang X, Emdin A, et al. Visits to the emergency department by community-dwelling people with dementia during the first 2 waves of the COVID-19 pandemic in ontario: A repeated cross-sectional analysis. CMAJ Open 2022;10(3):E610–E621.
Tinetti M, Huang A, Molnar F. The geriatrics 5M's: A new way of communicating what we do. J Am Geriatr Soc 2017;65(9):2115.
Zhu CW, Sano M. Demographic, health, and exposure risks associated with cognitive loss, Alzheimer's disease and other dementias in US military veterans. Front Psychiatry 2021;12:610334.
Richard-Eaglin A, Campbell JG, Utley-Smith Q. The aging veteran population: Promoting awareness to influence best practices. Geriatr Nurs 2020;41(4):505–7.
Rehm J, Hasan OSM, Black SE, et al. Alcohol use and dementia: A systematic scoping review. Alzheimers Res Ther 2019;11:1.
Davis BC, Bajaj JS. Effects of alcohol on the brain in cirrhosis: Beyond hepatic encephalopathy. Alcohol Clin Exp Res 2018;42(4):660–7.
Ibanez-Samaniego L, Rapado-Castro M, Cabrero L, et al. Hepatitis C eradication improves cognitive function in patients with or without cirrhosis: A prospective real-life study. Eur J Neurol 2022;29(2):400–12.
Guo Z, Cupples LA, Kurz A, et al. Head injury and the risk of AD in the MIRAGE study. Neurology 2000;54(6):1316–23.
Fleminger S, Oliver DL, Lovestone S, et al. Head injury as a risk factor for Alzheimer's disease: The evidence 10 years on; a partial replication. J Neurol Neurosurg Psychiatry 2003;74(7):857–62.
Peters R, Poulter R, Warner J, et al. Smoking, dementia and cognitive decline in the elderly, a systematic review. BMC Geriatr 2008;8(1):36.
van der Flier WM, Scheltens P. Epidemiology and risk factors of dementia. J Neurol Neurosurg Psychiatry 2005;76(Suppl 5):v2–7.