The discussion below came from an article in our newsletter about brain fog due to hepatic encephalopathy, or HE, which is a challenge for anyone with cirrhosis. An issue for a patient or a caregiver is that it can come and go and patients can find themselves away from home and in trouble as the ammonia disrupts your cognitive functions. You can seem demented or on drugs to others. That can be a life threatening situation so we advise patients with advancing liver disease to get a bracelet or some kind of wearable sign that can inform others what the problem may be. There are a number of alternatives, but the one we like is MyID. Here is a link to their site.
The reason we like it is because it provides more than just a message. It also provides a way for the police, EMT's or docs to get your medical information online. You can store your medical data for free and make it accessible for your care team. This is a big benefit to just having a warning label.
The rest of this is from our newsletter as a little background about the problem.
Do you, or someone you care about, feel like you are losing your mental ability? Can't think as well as you used to? Is it Alzheimer's, old age, something worse? These problems are well known, but we usually ignore the fact that liver disease can also steal your mind. Hepatic Encephalopathy, often called HE for short, is a disruption of brain function that is a serious complication of liver disease. If the liver is not removing ammonia from the blood because it has been damaged, The result is a buildup of toxins in the bloodstream that disrupt normal functions and can lead to confusion, coma and death.
Something we never talk about are the sub clinical effects of liver damage. Millions of people have liver disease without symptoms. I recently had a discussion with a woman who was apparently doing OK but one day was found wandering in the street talking crazily to herself. Clearly a mentally ill person. The police picked her up and took her to the station while they tried to figure out who she was. We have all seen these poor souls in our communities with obvious problems. In her case, she went into a coma and nearly died when the police left her in a room while they tried to find out who she was. She spent 3 days in ICU before getting her ammonia levels down. That caused me to wonder about people with just a little ammonia.
A question we should be asking is how many are suffering from liver disease rather than the mental illness we assume when we see odd behavior, but those are the critical cases. More broadly, what about people who have just a little rogue ammonia? How many of us dismiss failures of memory or confusion to just an aging brain when it is really a bit of toxic poisoning? I wonder. The problem is that we don't know. We do not screen for early stage liver disease and we have very little awareness of how it really affects the asymptomatic victim. We easily suggest dementia, Alzheimer's or just normal aging but almost never consider a liver disease.
If you aren't familiar with HE, hepatic encephalopathy, here is a link to some information which also will give you a link to a very well done documentary featuring real patients. If you are merely obese or have some other disease like diabetes, you might want to consider whether some of your troubles could be from a damaged liver that hasn't yet given you problems serious enough to get a diagnosis.