The findings of this cohort study suggest that, in a national veterans cohort of patients with dementia, 5% to 10% of the patients have laboratory values suggestive of possible undiagnosed cirrhosis that could implicate HE as a contributor to overall cognitive impairment. Patients in this study with possibly undiagnosed cirrhosis were more likely to be of races other than White, Hispanic, and urban-dwelling, and more likely to have AUD and viral hepatitis. These percentages of affected patients were corroborated with medical records review of 2 separate validation cohorts. In conclusion, FIB-4 should be considered as a screening tool to detect cirrhosis and potential HE in older veterans with dementia. Those with high scores (eg, >2.67) should be considered for further evaluation and treatment.

Undiagnosed Cirrhosis and Hepatic Encephalopathy in a National Cohort of Veterans With Dementia — JAMA Netw Open. 2024;7(1):e2353965. doi:10.1001/jamanetworkopen.2023.53965 — https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2814346