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Cognitive Deficit and White Matter Changes in Persons with Celiac Disease: a Population-Based Study

Croall ID, Sanders DS, Hadjivassiliou M, Hoggard N. (2020) Gastroenterology.   pii: S0016-5085(20)30239-0. doi: 10.1053/j.gastro.2020.02.028. [Epub ahead of print] 

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There is debate over the presence and prevalence of brain injury in patients with celiac disease. To validate previous reports, we investigated the prevalence of neuropsychological dysfunction in persons with celiac disease included in the National UK Biobank, which contains experimental medical data from 500,000 adults in the United Kingdom.


Biobank participants with celiac disease (n=104; mean age, 63; 65% female) were matched with healthy individuals (controls, n=198; mean age, 63 y; 67% female) for age, sex, level of education, body mass index, and diagnosis of hypertension. All subjects were otherwise healthy. We compared scores from 5 cognitive tests, and multiple-choice responses to 6 questions about mental health, between groups using t test and χ2 analyses. Groupwise analyses of magnetic resonance imaging brain data included a study of diffusion tensor imaging metrics (mean diffusivity, fractional anisotropy, radial diffusivity, axial diffusivity), voxel-based morphometry, and Mann-Whitney U comparisons of Fazekas grades.


Compared with controls, participants with celiac disease had significant deficits in reaction time (P=.004) and significantly higher proportions had indications of anxiety (P=.025), depression (P=.015), thoughts of self-harm (P=.025) and health-related unhappiness (P=.010). Tract-based spatial statistics analysis revealed significantly increased axial diffusivity in widespread locations, demonstrating white matter changes in brains of participants with celiac disease. Voxel-based morphometry and Fazekas grade analyses did not differ significantly between groups.


In an analysis of data from the UK Biobank, we found participants with celiac disease to have cognitive deficit, indications of worsened mental health, and white matter changes, based on analyses of brain images. These findings support the concept that celiac disease is associated with neurological and psychological features.


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