Cognitive Impairment and Cirrhosis in Older Patients: A Systematic Review

Prevalence of cirrhosis and hepatic encephalopathy (HE) in older patients receiving care in long-term care settings is unknown. This systematic review aimed to identify potential factors associated with HE and cognitive impairment in older patients with cirrhosis. A PubMed search of English-language articles published between January 1, 2000, and November 3, 2021, was conducted to identify studies in adults with cirrhosis relevant to cognitive impairment and/or HE (e.g., fall, frailty, and sarcopenia). Of 2,879 English-language publications, 24 were included. In patients with cirrhosis, falls were increased in the presence of HE and were associated with increased injury risk. Frailty was associated with HE development and cognitive impairment in patients with cirrhosis. Further, cognitive impairment and frailty were predictive of HE-related hospitalizations. Sarcopenia increased the risk of developing HE. Furthermore, specific medications increased the risk of developing HE. Risk reduction and management of patients with HE are critical to prevent negative outcomes.