Reader Response: Association of Nonalcoholic Fatty Liver Disease and Fibrosis With Incident Dementia and Cognition: The Rotterdam Study

Xiao et al.1 observed that nonalcoholic fatty liver disease (NAFLD) is associated with a reduced risk of dementia and cognitive decline for the first 5 years of the disease, which is possibly driven by weight loss before the onset of dementia. The biology of any illness is the outcome of a meticulously orchestrated parallel activation of multiple physiologic processes constituting the cause-effect-adaptive continuum that pushes or pulls the patient toward or away from any disease, including dementia.2