My brother has tremors and forgetfulness. Can it be dementia?

Question

Hello doctor,

My brother, aged 45, was under treatment for liver problems for two years. In recent weeks, he started forgetting things, could not draw or write properly, had slurred speech at night, and a flapping tremor in his hands when holding a glass.

Doctors checked his ammonia (180 µmol/L, high) but said it is in the normal range for people with cirrhosis. Now he is mixing up days. My concerns are:

Is he developing any serious complications due to liver disease, or is it early-stage dementia?
Should we consult a neurologist?
Are any special tests, like brain imaging, needed?

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

From what you are describing, this does not sound like early dementia. The forgetfulness, difficulty writing, slurred speech, especially in the evening, and the flapping movement of his hands when he holds a glass are very typical signs of hepatic encephalopathy, which is a complication of advanced liver disease.

An ammonia level of 180 µmol/L (micromol per liter) is quite high, and when someone with cirrhosis develops these symptoms, we take it seriously.

While ammonia levels alone do not always tell the full story, the combination of his laboratory values and his behavior changes strongly suggests that his liver is struggling to clear toxins, and those toxins are affecting his brain.

Dementia usually develops gradually over a long period of time and does not typically cause a flapping tremor. The fact that his symptoms seem to fluctuate and are worse at certain times of day also fits more with hepatic encephalopathy.

The good news is that, unlike dementia, this condition is often reversible if treated properly and if we identify what triggered it. Common triggers include constipation, infection, dehydration, internal bleeding, kidney problems, or certain medications. These need to be actively checked.

At this point, he should be seen urgently by his liver specialist or physician. A neurologist is not usually the first doctor needed unless there are unusual signs such as weakness on one side, severe headache, or seizures.

Brain imaging is not always necessary if the clinical picture clearly fits hepatic encephalopathy, but doctors may order a scan if they want to rule out stroke or bleeding, especially if symptoms appeared suddenly. This is a serious complication of liver disease, but it is treatable, and many patients improve significantly with medications like lactulose and sometimes Rifaximin.

Please do not delay getting him evaluated because early treatment can prevent worsening and can even bring him back to his usual self.

I hope this helps.

Thank you.

My brother has tremors and forgetfulness. Can it be dementia?

Recognize signs of hepatic encephalopathy.