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Cognitive Function of Patients with Crohn's Disease is Associated with Intestinal Disease Activity

Golan, Daniel MD, MPH*,†; Gross, Bella MD‡,§; Miller, Ariel MD, PhD*,†; Klil-Drori, Sivan MD*; Lavi, Idit MA; Shiller, Moshe MD§,¶; Honigman, Silvia MD*,†; Almog, Ronit MD, MPH**,††; Segol, Ori MD‡‡

doi: 10.1097/MIB.0000000000000594
Original Clinical Articles

Background: Systemic inflammation and nutritional deficiencies are characteristics of Crohn's disease (CD) and have been suggested to influence cognitive performance. This study assessed cognitive function in patients with CD.

Methods: Participants were adult patients with CD arriving at routine follow-up. Subjective cognitive complaints, depression, anxiety, fatigue, and sleep were evaluated by validated questionnaires. CD characteristics, blood tests, and Crohn's disease activity index were obtained. Nutritional risk index was derived from serum albumin and change in body weight. Montreal cognitive assessment was used for screening. Patients with either subjective cognitive complaints or Montreal cognitive assessment score ≤26 were tested by a computerized cognitive testing battery, with analysis of scores in 7 cognitive domains (CogDs) and an average of the CogD scores-global cognitive score (GCS). Impaired CogD was defined as scoring more than 1 SD below age and education adjusted average.

Results: A total of 105 patients were recruited and 61 were tested with computerized cognitive testing battery. Mean age was 39 ± 13 and mean education years were 14 ± 2. The most commonly impaired CogDs were information processing speed (33%) and verbal function (28%). Crohn's disease activity index, nutritional risk index, and hemoglobin were significantly correlated with GCS (r = −0.34, 0.39, 0.33; P = 0.007, 0.003, 0.01). Linear regression revealed significant correlations between Crohn's disease activity index, nutritional risk index, and GCS (β = −0.3, 0.29; P = 0.03, 0.04), independent of depression. This model explained 24% of the variance in GCS.

Conclusions: Cognitive performance is related to CD activity and nutritional status. The results provide insight into potential influence of nutrition and inflammation on cognitive function. Further studies on cognitive function of patients with CD are warranted.

Article first published online 18 September 2015.

*Department of Neurology and Neuroimmunology unit, Lady Davis Carmel Medical Center, Haifa, Israel;

Ruth and Bruce Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa, Israel;

Department of Neurology, Galilee Medical Center, Nahariya, Israel;

§Faculty of Medicine in the Galilee, Bar Ilan University, Israel;

Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel;

Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel;

**School of Public Health, Haifa University, Haifa, Israel;

††Epidemiolgy Unit, Rambam Health Care Center, Haifa, Israel; and

‡‡Department of Gastroenterology, Lady Davis Carmel Medical Center, Haifa, Israel.

Reprints: Daniel Golan, MD, MPH, Department of Neurology, Carmel Medical Center, 7 Michal Street, Haifa 34362, Israel (e-mail:

The author has no conflicts of interest to disclose.

R. Almog and O. Segol have contributed equally to this work.

Received July 27, 2015

Accepted August 06, 2015

© Crohn's & Colitis Foundation of America, Inc.
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