title: Cognitive impairment in coeliac disease improves on a gluten-free diet and correlates with histological and serological indices of disease severity.
abstract: BACKGROUND
  Mild impairments of cognition or 'Brain fog' are often reported by patients with coeliac disease but the nature of these impairments has not been systematically investigated.
  
  
  OBJECTIVE
  This longitudinal pilot study investigated relationships between cognitive function and mucosal healing in people with newly diagnosed coeliac disease commencing a gluten-free diet.
  
  
  METHODS
  Eleven patients (8 females, 3 males), mean age 30 (range 22-39) years, were tested with a battery of cognitive tests at weeks 0, 12 and 52. Information processing efficacy, memory, visuospatial ability, motoric function and attention were tested. Small bowel biopsies were collected via routine gastroscopy at weeks 12 and 52 and were compared to baseline Marsh scores. Cognitive performance was compared to serum concentrations of tissue transglutaminase antibodies, biopsy outcomes and other biological markers.
  
  
  RESULTS
  All patients had excellent adherence to the diet. Marsh scores improved significantly (P = 0.001, Friedman's test) and tissue transglutaminase antibody concentrations decreased from a mean of 58.4 at baseline to 16.8 U/mL at week 52 (P = 0.025). Four of the cognitive tests assessing verbal fluency, attention and motoric function showed significant improvement over the 12 months and strongly correlated with the Marsh scores and tissue transglutaminase antibody levels (r = 0.377-0.735; all P < 0.05). However, no meaningful patterns of correlations were found for nutritional or biochemical markers, or markers of intestinal permeability.
  
  
  CONCLUSIONS
  In newly diagnosed coeliac disease, cognitive performance improves with adherence to the gluten-free diet in parallel to mucosal healing. Suboptimal levels of cognition in untreated coeliac disease may affect the performance of everyday tasks.
authors.affiliation: School of Psychological Sciences, Monash University, Clayton, Australia.
authors.forename: I T
authors.initials: IT
authors.lastname: Lichtwark
authors.forename: E D
authors.initials: ED
authors.lastname: Newnham
authors.forename: S R
authors.initials: SR
authors.lastname: Robinson
authors.forename: S J
authors.initials: SJ
authors.lastname: Shepherd
authors.forename: P
authors.initials: P
authors.lastname: Hosking
authors.forename: P R
authors.initials: PR
authors.lastname: Gibson
authors.forename: G W
authors.initials: GW
authors.lastname: Yelland
mesh_terms: D000328:Adult; D000906:Antibodies / Q000097:blood / Q000276:immunology; D002446:Celiac Disease / Q000097:blood / Q000178:diet therapy* / Q000276:immunology / Q000473:pathology / Q000523:psychology; D003072:Cognition Disorders / Q000097:blood / Q000178:diet therapy* / Q000276:immunology / Q000473:pathology / Q000523:psychology; D055050:Diet, Gluten-Free; D004386:Duodenum / Q000276:immunology / Q000473:pathology; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000276:immunology / Q000473:pathology; D008297:Male; D011581:Psychological Tests; D012720:Severity of Illness Index; D011503:Transglutaminases / Q000276:immunology; D055815:Young Adult
chemical_list: D000906:Antibodies; D011503:Transglutaminases