Investigators at the Celiac Disease Center at Columbia University have found that, despite cognitive effects reported by celiac disease patients, there is no increased risk for dementia before or after a celiac disease diagnosis.
About the study
It is well-known that gluten can cause negative cognitive effects in people with celiac disease, such as “brain fog,” confusion, forgetfulness and memory lapse, lack of concentration and more. But the real question has been - do these cognitive effects have long-term consequences, such as an increased risk of dementia? A new study, published in the Journal of Alzheimer’s Disease, says no.
Researchers have found that celiac disease does not increase the risk of developing Alzheimer’s. After following a group of 8,846 people, aged 50 and older, over an average of 8.4 years, the team with the Celiac Disease Center at Columbia University found that the rate of developing dementia was equal in the cases (people with celiac disease) and the controls (people without celiac disease).
Although celiac disease has no effect on the risk of Alzheimer’s, researchers did detect a small risk in vascular dementia, also known as cognitive impairment that is caused by problems in blood supply to the brain.
So, what does this mean?
Although many people with celiac disease report serious cognitive symptoms both before and sometimes after diagnosis, it is important to know that these symptoms will very likely not lead to Alzheimer’s later in life.
However, because people with a family history of Alzheimer’s are at an increased risk for developing the condition, it’s important discuss all family medical history with a healthcare provider. You can learn more about Alzheimer’s, including the 10 warning signs of disease, here.
To get more information on this study, we asked the lead author of the study, Benjamin Lebwohl, MD, Assistant Professor of Medicine and Epidemiology, Columbia University Medical Center, to answer some of our questions.
Q. If the cognitive symptoms people with celiac disease experience both before and after diagnosis do not lead to Alzheimer’s, were there any other long-term serious complications also ruled out? In other words, how significant do you think these cognitive symptoms might be in the long run?
A common and serious cognitive disorder in older people is Alzheimer’s dementia. We know that the cognitive symptoms referred to as “brain fog” in patients with celiac disease are common, and they can cause a considerable amount of distress. We were concerned that dementia could occur at a greater frequency in patients with celiac disease. We were relieved to find that, in fact, the rate of Alzheimer’s dementia is not more common in patients with celiac disease than that which would be expected in the general population.
Q. Can you explain why cognitive symptoms, such as “brain fog,” occur in people with celiac disease?
A. The honest answer is that we do not know yet. Some believe that this is a consequence of systemic inflammation that is induced by exposure to gluten. Others believe that the antibodies similar to those that are commonly elevated in celiac disease (tissue transglutaminase) can bind to nerve tissue, though a definitive link between that and “brain fog” has not been established. This is one of the top areas in need of further study because the symptom of “brain fog” is so commonly reported and can impair quality of life for our patients.
Q. What follow-up care or management tips do you suggest for celiac disease who continue to experience cognitive symptoms despite eating a strict gluten-free diet?
A. People with these symptoms should check in with a provider who is expert in celiac disease, as gluten exposure may still be occurring despite best efforts at adhering to the diet. Other possibile causes of these symptoms are vitamin deficiencies or another systemic disorder unrelated to celiac disease.
Q. What is vascular dementia and why/how does it develop?
A. This refers to cognitive problems due to insufficient blood supply to the brain. At times this occurs after a stroke or a series of strokes, but in other situations it develops without a discrete stroke but as a result of silent insults to the brain. It is due to vascular disease, that is to say defects in the blood vessels that carry blood to the brain.
Q. What is the connection between vascular dementia and celiac disease, and how does it impact celiac disease patients? What is your advice for managing this risk?
A. The connection has not been well established. We found that there appears to be a small increase in the rate of vascular dementia in patients with celiac disease compared to controls. We do know from prior studies that there is a small increase in stroke risk in celiac disease, and the reason for this risk is unknown. Perhaps our finding is related to stroke risk, but it also may be due to chance given the small effect size. It is premature to draw conclusions about vascular dementia and celiac disease based on this study, but we are interested in following up on this to determine whether there is a risk and how it can be managed.
Q. Is there anything else you think people should know about this study?
A. There has been much written about the effects of grains on brain function, and much of it is based on speculation as opposed to science. But given the interest on that topic, and the concern that it has raised among our patients, we wanted to know if these effects “add up” with regard to a risk of dementia. It turns out that despite “brain fog” being a prominent symptom among our patients, there is no overall increase risk of dementia. This is good news but surely there will be more studies to come.
A note from NFCA:
Like the Celiac Disease Center at Columbia University, NFCA also receives many questions from our community about “brain fog.” To learn more about how patients define this symptom and understand their experiences, NFCA collaborated with Daniel Leffler, MD, MS, Director of Research at the Celiac Center at BIDMC and Jessica B. Edwards George, PhD, NCSP, Assistant Clinical Professor at Northeastern University to develop, share and analyze the results of a survey among NFCA’s community. In 2013, NFCA presented these research findings from our collaborative project “Neurocognitive Effects of Gluten Exposure: Results of a Nationwide Survey” at the 15th International Celiac Disease Symposium. You can read more about this project here.