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  • Jefferson Adams
    Jefferson Adams

    Older Celiac Patients on Gluten-free Diet Show Reduced Cognitive Performance

    Reviewed and edited by a celiac disease expert.

    Celiac.com 06/21/2012 - Retrospective studies and case reports have suggested that older patients with celiac disease may suffer from impaired cognitive function. To evaluate this possibility, a research team recently conducted a study of people with celiac disease who are over age 65.

    Photo: CC--jugboThe researchers included S. Casella, B. Zanini, F. Lanzarotto, C. Ricci, A. Marengoni, G. Romanelli, A. Lanzini, of the Gastroenterology Unit of the Department of Medicine at University and Spedali Civili in Brescia, Italy.

    The researchers wanted to evaluate functional and cognitive performances in celiac disease, and in control patients, older than 65 years.

    For their study, they recruited 18 celiac disease patients aged 75-years or older (±4 years, group A) who had been on a gluten free diet for an average of 5.5 years (±3 years), along with a control group of 18 patients matched for sex and age, averaging 76 years of age (±4 years, group B).

    The team then administered a number of functional and cognitive neuropsychological tests. They recorded the results as "row scores" and as "equivalent scores" by relating "raw scores" to reference rank categories.

    For the functional tests, they found that the Barthel Index of functional performance was similar for both groups.

    However, for the cognitive tests, they found that the "raw score" was significantly lower in celiac disease than controls. The cognitive tests included Mini Mental Test Examination (p=0.02), Trail Making Test (p=0.001), Semantic Fluency (p=0.03), Digit Symbol Test (p=0.007), Ideo-motor apraxia (p

    The also found that the "equivalent score" was also lower in celiac disease than controls for tests of Semantic memory. The results showed that cognitive performance is worse in elderly patients with celiac disease than in healthy control patients, despite prolonged treatment with a gluten-free diet.

    They write that "awareness on the increasing phenomenon of late-onset celiac disease is important to minimize diagnostic delay and prolonged exposure to gluten that may adversely and irreversibly affect cognitive function."

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    The title of the article and what the conclusions showed were contradictory. The title suggests that the gluten-free diet may have some bearing on patient cognition, but the article suggests that patients with celiac disease may suffer from a decline in cognition. This was confusing for me. There are a great many people on the gluten-free diet who do not suffer from celiac disease.

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    I was diagnosed celiac disease at the end of January and since May, I have been following a gluten-free diet. Last month my doctor began giving me B12 shots so I do hope they will help with cognition.

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    I am younger than that and I have such issues. I can't think of words even if I know of them. I forget things as well. I can also get very angry too over stuff I have no control of. I found I can't eat other things as well as gluten.

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    Nutritional deficiencies related to malabsorption of vitamins, minerals, and simple carbohydrates are clearly associated celiac disease, as well as gluten sensitivity, such that patients present with anemia, osteoporosis, low blood sugar, etc. – many of which can impact cognitive function.

     

    Doctors needs to key in on this with patients of all ages to diagnose and support them with not only a gluten-free but vitamin and mineral supplements to restore as soon as possible any longstanding deficits. This therapy should also include omega-3 oil (despite a recent study that disputed omega's connection to brain health). Even if negative for celiac disease, anyone with diseases related to malabsorption, the gastrointestinal system, inflammation, chronic infections and many others should be placed on a trial gluten-free diet for a month as gluten is a known inflammatory. (One major hospital in Boston recommends that folks going through chemotherapy avoid gluten intake to decrease inflammation and lessen potential nausea.) Chances are many elders present with arthritis, gastrointestinal, cardiac issues, and other disorders often dismissed as simple aging issues.

     

    With my diagnosis, I am more convinced that my parents also had issues directly related to gluten. A small town near me received a grant to test elders for celiac disease, and they identified 2-3 folks with celiac disease with long-standing medical issues that are related to the disease.

     

    I can tell you that I feel younger, and people have noted that I look younger since my gluten-free diet. Wouldn't it be great if someone could prove that many "old-age" disorders are associated with gluten or are more severe due to the intake of gluten? Wouldn't it be wonderful if we could eliminate or lessen the use of prescription medications by simply putting elders (and others with chronic disorders) on a gluten-free diet?

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    Guest marketing@celiac.com

    Posted

    The title of the article and what the conclusions showed were contradictory. The title suggests that the gluten-free diet may have some bearing on patient cognition, but the article suggests that patients with celiac disease may suffer from a decline in cognition. This was confusing for me. There are a great many people on the gluten-free diet who do not suffer from celiac disease.

    Sorry for the confusion. We wanted to make it clear that the gluten-free diet does not seem to help prevent or reverse this, which is of course unfortunate.

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    Guest marketing@celiac.com

    Posted

    How would you prove that cognitive performance is not just a result of their age in general? Some of these studies make no sense at all....

    Control group!

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    How would you prove that cognitive performance is not just a result of their age in general? Some of these studies make no sense at all....

    It is true, I felt it on myself.

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    It's important to note that if they are 65+ and have only been on the gluten-free diet for ~5.5 years average, then that means most of them discovered celiac disease and started gluten-free diet relatively late in their lives.

     

    The article should point out that this study really says nothing about cognitive effects for people who been on the gluten-free diet much longer than 5 years and those who are younger, of course.

     

    Also, for a proper control, they include the newly diagnosed- confirmed celiacs who haven't started the diet yet.

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    Oh also, the p value simply means that the populations are distinctly statistically different. "Significant" in scientific writing simply means not a result of chance, not to be confused with significant meaning huge difference. The actual difference they didn't go to at all, other than the obvious lower numbers- by how much?

     

    Or more simply, the difference in scores does not necessarily imply a level of cognitive difference that would be noticeable by a normal person in their daily lives.

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  • About Me

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, science, and advanced research, and scientific methods. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

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