From Our 2006 Archives
Celiac Disease Linked to Dementia
Gluten-Free Diet May Reverse Mental Decline in Patients
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.
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