Cognitive Impairment and Celiac Disease

Abstract

Objective: To characterize the clinical, radiological, and electrophysiological laboratory profiles and histological features of patients who developed cognitive impairment temporally associated with celiac disease.Design: Case series.Setting: Referral center. Patients:Patients with the onset of progressive cognitive decline within 2 years of symptomatic onset or with a severe exacerbation of biopsy-proved adult celiac disease were identified from the Mayo Clinic medical records from January 1, 1970, to December 31, 2005. Patients were excluded if an alternate cause of their cognitive impairment was identified.Results: Thirteen patients (5 women) were identified. The medianageatcognitiveimpairmentonsetwas64years(range, 45-79 years), which coincided with symptom onset or exacerbation of diarrhea, steatorrhea, and abdominal cramping in 5 patients. Amnesia, acalculia, confusion, and personality changes were the most common presenting features.The average initial Short Test of Mental Status score was 28 of a total of 38 (range, 18-34), which was in the moderately impaired range. The results of neuropsychological testing suggested a trend of a frontosubcortical pattern of impairment. Ten patients had ataxia, and 4 of them also had peripheralneuropathy.Magneticresonanceimagingofthehead showednonspecificT2hyperintensities,andelectroencephalography showed nonspecific diffuse slowing. Deficiencies in folate, vitamin B 12 , vitamin E, or a combination were iden-tifiedin4patients,yetsupplementationdidnotimprovetheir neurological symptoms. Three patients improved or stabilized cognitively with gluten withdrawal. A detailed histological analysis revealed nonspecific gliosis. Conclusions:A possible association exists between progressive cognitive impairment and celiac disease, given the temporal relationship and the relatively high frequency of ataxia and peripheral neuropathy, more commonly associated with celiac disease. Given the impact for potential treatment of similar cases, recognition of this possible association and additional studies are warranted.

Celiac Disease and Autoimmunity in the Gut and Elsewhere

“…[51] Cognitive decline, dementia, myopathy, and a rarer clinical condition involving epilepsy and cerebral calcifications in relation to CD have been described in case reports and series. [52][53][54][55] Several recent studies have evaluated the prevalence and clinical presentation of ataxia and peripheral neuropathy associated with CD, as well as the potentially gluten-dependent neurological conditions occurring in the absence of enteropathy. Gluten ataxia is considered a distinct disease process which can occur with or without enteropathy and is associated with high anti-gliadin antibody titers.…”

The liver in celiac disease

“…1,5 CD itself may injure the liver but also may modify the clinical impact of chronic liver diseases when they coexist. The aims of this review are (1) to explore the spectrum and pathogenesis of liver abnormalities described in CD and (2) to summarize the association between CD and various chronic liver disorders to provide a basis for a rational diagnostic and therapeutic approach that those who care for patients with liver disease can incorporate into practice.…”

A Review and Perspective on Maximizing Brain Plasticity: Priming the Nervous System to Learn

“…6 Fifty years ago, students learned the nervous system was only adaptable and plastic during the developmental years, physical exercise was only needed if you were going to play a sport, heavy labor was a common component of traditional work, many were without cars and walked to work/school and the average longevity was less than 70 years. Today we are living longer, immobility is a primary health problem [8][9][10] falls in the elderly are common 11 over 70 million people will be stroke survivors by 2030 12,13 opiod addiction is a national crisis with serious adverse events. 14,15 Alzheimer's Disease is considered as a "Type 3 Diabetes" 7,16 stressful, stereotypical repetitive job tasks are degrading cortical representations and disrupting voluntary motor control 17,18 auto immune diseases are on the rise and the population is consuming excessive amounts of gluten 7,19,20 Gluten (a sticky protein) is associated with a leaky gut and an increase in inflammation and cytokines in the vital organs, especially the brain.…”

“…Given some consumers and health care practitioners doubt the science of plasticity, it is not surprising some individuals are unwilling to commit to exercise, follow a nutritious diet, drink adequate fluids, achieve adequate sleep, address stress, stop smoking or decrease ETOH consumption Thus, a large percent of the population is pathologically overweight, depressed, isolated, challenged with chronic pain and have lost the motivation to learn, think positively and set meaningful goals 8,10 These individuals put physiological systems, especially the brain, at risk for oxygen deprivation and central hypersensitivity 3,8,9,14,23,24 Further, while older people are worried about developing Alzheimer's disease as a consequence of aging, many still chose to isolate themselves at home and disengage from challenging learning activities 9,6 In fact, these life style issues may contribute more to falls and cognitive decline than aging or genetics. 8,9,27 To facilitate maximum neuroplasticity the body, especially the brain, may need to be "primed" for learning.…”