Brain Fog

[DrMom]

Celiac Disease Linked to Dementia

Gluten-Free Diet May Reverse Mental Decline in Patients

By Salynn Boyles

WebMD Medical News

Reviewed By Louise Chang, MD

on Friday, October 13, 2006

Oct. 13, 2006 -- Adults who develop the digestive condition known as celiac disease appear to be at increased risk for dementia , according to new research from the Mayo Clinic.

Celiac disease is a disorder caused by an immune reaction to eating gluten, found in some grains such as wheat, barely, and rye. Damage occurs to the inner lining of the small intestine. Classic symptoms include chronic diarrhea, weight loss, cramping, bloating, and gas.

About 10% of celiac patients have some neurologic symptoms, such as numbness and pain. But a link to dementia and other forms of mental decline has not been widely reported.

Mayo Clinic neurologist Keith A. Josephs, MD, MST, tells WebMD that he first made the connection when examining a patient suspected of having the fatal brain disorder Creutzfeldt-Jakob disease (CJD).

The patient did not have CJD, but he did have celiac disease. He also had rapid-onset dementia, which coincided with the onset of diarrhea and other well-recognized symptoms of the digestive disease.

"I wanted to find out if the dementia was related to the celiac disease," Josephs says.

Gluten-Free Diet Reversed Dementia

Josephs and colleagues including William T. Hu, MD, PhD, examined the medical histories of 13 patients who showed evidence of serious mental declines within two years of developing symptoms of celiac disease.

The patients were between the ages of 45 and 79, and their average age was 64.

In five cases, celiac symptoms and mental decline occurred simultaneously. Two of the patients also recovered mental function when they followed gluten-free diets, and mental function stabilized in one patient.

Avoiding wheat and other gluten-containing grains is the main treatment for celiac disease.

"This is a big deal," Josephs says. "It is almost unheard of to see a reversal in dementia or cognitive decline."

The next step, he says, is to try and figure out the connection between celiac disease and mental deterioration. One theory is that the immune response to celiac disease attacks the brain. Another is that the disease causes inflammation within the brain, which triggers dementia.

Mayo clinic gastroenterologist and celiac disease expert Joseph Murray, MD, says he was surprised that the link was so strong.

"I was not expecting that there would be so many celiac disease patients with cognitive decline," he said.

Celiac Often Misdiagnosed

Celiac disease is common, occurring in about one in 133 people, Murray says. But it is often misdiagnosed or missed altogether due to the vague nature of the symptoms.

The new findings give doctors an added reason to identify patients with celiac disease and to treat patients who have been diagnosed, the researchers conclude.

That means ruling out celiac disease in patients who have atypical forms of dementia and being watchful for mental decline in celiac patients.

--------------------------------------------------------------------------------

SOURCES: Hu, W.T. Archives of Neurology, October 2006; vol 63, online edition. Keith A. Josephs, MD, MST, neurologist, Mayo Clinic, Rochester, Minn. Joseph A. Murray, MD, gastroenterologist, Mayo Clinic, Rochester, Minn.

© 2006 WebMD Inc. All rights reserved.

[DrMom]

Potential Link Between Celiac Disease And Cognitive Decline Discovered By Mayo Clinic

11 Oct 2006

Mayo Clinic researchers have uncovered a new link between celiac disease, a digestive condition triggered by consumption of gluten, and dementia or other forms of cognitive decline. The investigators' case series analysis -- an examination of medical histories of a group of patients with a common problem -- of 13 patients will be published in the October issue of Archives of Neurology.

"There has been very little known about this connection between celiac disease and cognitive decline until now," says Keith Josephs, M.D., Mayo Clinic neurologist and study investigator. "This is the largest case series to date of patients demonstrating cognitive decline within two years of the onset of celiac disease symptom onset or worsening."

Says Joseph Murray, M.D., Mayo Clinic gastroenterologist and study investigator, "There has been a fair amount written before about celiac disease and neurological issues like peripheral neuropathy (nerve problems causing numbness or pain) or balance problems, but this degree of brain problem -- the cognitive decline we've found here -- has not been recognized before. I was not expecting there would be so many celiac disease patients with cognitive decline."

The next step in the research will be to investigate the measure and nature of the connection between the two conditions.

"It's possible it's a chance connection, but given the temporal link between the celiac symptoms starting or worsening and the cognitive decline within a two-year time span, especially the simultaneous occurrence in five patients, this is unlikely a chance connection," says Dr. Josephs. "Also, these patients are relatively young to have dementia."

Theories to explain the connection between celiac disease and cognitive decline include the following, according to Dr. Murray:

* Nutritional deficiency

* Inflammatory cytokines -- chemical messengers of inflammation that could contribute to problems in the brain

* An immune attack on the brain that may occur in some patients with celiac disease

The cognitive decline that occurred in three of the celiac disease patients studied, according to Dr. Josephs, is relatively unique in its reversal in two of the patients and stabilization in one patient. Typically, cognitive decline continues to worsen, he says. "This is key that we may have discovered a reversible form of cognitive impairment," he says.

William Hu, M.D., Ph.D., Mayo Clinic neurology resident and study investigator, says that the reversal or stabilization of the cognitive symptoms in some patients when they underwent gluten withdrawal also argues against chance as an explanation of the link between celiac disease and cognitive decline.

Currently, the investigators do not know which celiac disease patients are at risk for cognitive decline; this deserves future investigation, says Dr. Hu.

Dr. Murray suggests that recognizing and treating celiac disease early will likely prevent most consequences of the disease, including symptoms in the gut or the brain. For celiac disease patients who have already developed cognitive decline, closely following a gluten-free diet may result in some symptom improvement, he says. For those with cognitive decline without a confirmed diagnosis of celiac disease, he does not recommend a gluten-free diet, however.

Physicians can play an important role in keeping alert to a potential celiac disease and cognitive decline connection, says Dr. Hu.

"For patients who come in with atypical forms of dementia, we need to consider checking for celiac disease, especially if the patients have diarrhea, weight loss or a younger age of onset -- under age 70," he says.

To conduct this case series analysis, the researchers identified 13 Mayo Clinic patients with documented cognitive impairment within two years of onset of symptoms or severe exacerbation of adult celiac disease. All celiac disease had been confirmed by small-bowel biopsy, and any patients for whom an alternate cause of cognitive decline could be identified were excluded from the analysis. Patients included five women and eight men, with a median onset of cognitive decline at age 64 that coincided with onset or worsening of symptoms of diarrhea, the presence of excess fat in the stools and abdominal cramping in five patients. The most common reasons for seeking medical help were amnesia, confusion and personality changes. The average score on the Short Test of Mental Status among the 13 patients was 28 out of 38 possible total, indicating moderate cognitive impairment. Ten patients experienced loss of coordination and four experienced symptoms of peripheral neuropathy. Four patients demonstrated deficiency in folate, vitamin B-12, vitamin E or a combination of these deficiencies, although supplementation did not improve the patients' cognitive decline. Three patients' cognitive decline either improved or stabilized when they completely withdrew from gluten consumption. A brain autopsy or biopsy was completed in five patients, and there was no evidence of Alzheimer's disease or any other well-known causes for dementia.

Celiac disease occurs in 1 out of 133 people and predominantly affects Caucasians, according to Dr. Murray. Symptoms can include intermittent diarrhea, abdominal pain and bloating, or no gastrointestinal symptoms at all. It can also manifest in weight loss, fatigue, anemia, general weakness, foul-smelling or grayish stools that may be fatty or oily, osteoporosis or stunted growth (in children only). The condition may also cause symptoms far outside of the gut. Nine out of 10 times, the disease is not discovered due to the vague nature of the symptoms, according to Dr. Murray. The treatment for celiac disease is a gluten-free diet. For further information on celiac disease, see Open Original Shared Link

[KarenLee]

I heard that on the news, but only caught part of the story, thanks for sharing that.

I noticed that you used Prometheus for your blood work, so did I. How long did it take for you to get the results?

Thanks,

Karen

[Nancym]

Isn't it interesting how we patients KNEW about the connection to celiac and the brain long before this article came out. I'm sure 90% of doctors will remain ignorant of the connection for at least another 10 years.

On my father's side of the family there is TONS of dementia and I do have one celiac gene. My other gene is a GS gene that is connected to brain damage from gluten.

:\

[DrMom]

The GI told me to call him in 2 weeks, but I called in one week and he had the results.

[Guest marshlakemom]

Nancy

I know, it is very disturbing that so many general practioners no nothing about celiac disease other than the basic symptoms like diarreah, bloating, gas, etc.

I took an article from the Mayo Clinic yesterday to my doctor on Celiac and Dementia, Celiac and Brain Fog, and Celiac and Cognitive Ability. She said, "Oh, I hadn't read anything about these symtom", and threw the articles in my file. I was a bit ticked at her. I hope she reads them, as I think any reports that come from the Mayo Clinic should be recognized.

I certainly know now, or believe that my brain fog is contributed to Celiac. Never could figure it out before, or could any doctor, after several tests.

Don't you???

Deb