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Abstract Details
Specific Challenges in Geriatric Cirrhosis and Hepatic Encephalopathy
1Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Virginia Commonwealth University and Richmond VA Medical Center, Richmond, Virginia. Electronic address: jasmohan.bajaj@vcuhealth.org.
2Division of Geriatrics, Department of Medicine, Virginia Commonwealth University and Richmond VA Medical Center, Richmond, Virginia.
3Division of Neuropsychology, Department of Psychiatry, Virginia Commonwealth University and Richmond VA Medical Center, Richmond, Virginia.
Abstract
As the world's population ages, diseases predominantly found in the elderly now overlap with diseases that were thought to be the purview of younger patients. This includes chronic liver disease, which affects more than 2 billion people worldwide. Owing to the obesity epidemic (and associated metabolic diseases), nonalcoholic fatty liver disease has become the most common cause of chronic liver disease and cirrhosis. A major complication of cirrhosis is hepatic encephalopathy (HE), which becomes challenging to diagnose in elderly patients. HE is usually included in the differential diagnosis of acute delirium but not of reversible dementias. To illustrate this point, we present 2 cases of older patients that were misdiagnosed as having dementia and Parkinson's disease or a parkinsonian syndrome but had contributions from cirrhosis. Both cognitive impairment and tremor resolved with treatment of HE.
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