White-matter changes, cognitive and mental-health deficits seen in celiac patients

Last Updated: 2020-03-05

By Anne Harding

NEW YORK (Reuters Health) - People with celiac disease have white-matter changes, cognitive deficits and worse mental health compared with healthy controls, according to new findings.

"The key point here is that some cognitive and mood problems can be expected even in 'typical' celiac disease, and that these appear to be driven by physical changes to the brain," Dr. Iain D. Croall of the University of Sheffield, in the UK, told Reuters Health by email. "This is not something which has generally been accepted into mainstream clinical opinion, and we hope that this study will help that happen."

Several studies have found indications of brain injury, cognitive deficit and worse mental health in people with celiac disease, Dr. Croall and his colleagues note in Gastroenterology. But estimates of neurological-symptom prevalence in celiac disease have had "strikingly different" results, they add, ranging from 0% to 50%.

The authors used data from the UK Biobank to compare 104 individuals with celiac disease to 198 healthy controls matched by age, sex, education, BMI, and hypertension diagnosis.

Using diffusion tensor imaging (DTI), the team found significantly greater axial diffusivity (AD) in the white matter of several brain regions in those with celiac disease than in controls. These regions included the cerebellum, brainstem, thalamus, forceps major of the corpus callosum and part of the superior longitudinal fasciculus.

Reaction time on a card-game task was increased in the patients (621.2 ms vs. 583.9 ms, P=0.004). They were also significantly more likely to report having ever felt "worried, tense or anxious" for a month or longer (31.5% vs. 18.0% of controls) and to endorse ever having had "prolonged feelings of sadness or depression" (58.4% vs. 41.4%).

Celiac-disease patients reported less general happiness with their own health, and were more likely to report thoughts of self-harm (19.5% vs. 9%, P=0.025). There were also trends toward higher levels of suicidal thoughts and worse sleep quality in the celiac-disease group.

The Biobank did not include information on when patients were diagnosed with celiac disease, disease duration, or information on gluten-free diet adherence. "Time since diagnosis is likely to be quite mixed with some recently diagnosed and some having held the diagnosis possibly for decades, and regarding dietary adherence is likely to be similar to how well people with celiac disease manage this in general," Dr. Croall said.

"It is important to point out that these details mean that the celiac population in our study will have been relatively mixed, and when this is the case in an experiment it becomes statistically harder to detect findings," he added. "This means our results if anything may be underestimating the extent of neurological and psychological difficulties in patients with celiac disease."

Understanding the possible negative effects of celiac disease on the brain can provide additional motivation to patients to follow a gluten-free diet, "as this is the only way to protect the brain in the longer term," Dr. Croall said, and can also help physicians provide more targeted care.

"At one extreme this may involve a doctor feeling more primed to make a neurological referral if they feel one is necessary. At the other extreme it might simply involve acknowledging the issue with the patient and giving their experience of this difficult condition more validity," he said. "Anecdotally, people with celiac disease express frustration that their cognitive issues, which they are very aware of, do not seem to be taken seriously by their doctor and this lack of belief is unhelpful for their wellbeing."

SOURCE: https://bit.ly/2vCYZb1 Gastroenterology, online February 20, 2020.