Specific Challenges in Geriatric Cirrhosis and Hepatic Encephalopathy

Area of Science:

• Geriatrics
• Hepatology
• Neurology

Background:

• Chronic liver disease affects over 2 billion people globally.
• Nonalcoholic fatty liver disease is the leading cause of chronic liver disease and cirrhosis, driven by the obesity epidemic.
• Hepatic encephalopathy (HE), a complication of cirrhosis, presents diagnostic challenges in the elderly, often mistaken for dementia or parkinsonian syndromes.

Purpose of the Study:

• To highlight the diagnostic challenges of hepatic encephalopathy (HE) in older patients.
• To illustrate how HE can be misdiagnosed as dementia or Parkinson's disease.
• To emphasize the importance of considering HE in the differential diagnosis of cognitive and motor impairments in elderly patients with cirrhosis.

Main Methods:

• Case report presentation of two elderly patients.
• Review of clinical presentation, diagnostic workup, and treatment outcomes.
• Analysis of the overlap between cirrhosis complications and neurodegenerative diseases.

Main Results:

• Two elderly patients initially misdiagnosed with dementia and Parkinson's disease respectively were found to have hepatic encephalopathy (HE) due to underlying cirrhosis.
• Cognitive impairment and tremors in both patients resolved after appropriate treatment for HE.
• This underscores the potential for HE to present atypically in the elderly population.

Conclusions:

• Hepatic encephalopathy (HE) should be considered in the differential diagnosis of reversible dementias and parkinsonian syndromes in elderly patients, especially those with risk factors for chronic liver disease.
• Timely diagnosis and management of HE can lead to significant improvement in neurological symptoms.
• Increased awareness and diagnostic vigilance are crucial for managing HE in an aging population with rising rates of metabolic liver disease.