An inflammatory bowel disease, Crohn’s disease primarily affects the gastrointestinal tract, but it also has a negative impact on the brain. Due to its troublesome symptoms that include diarrhea with bloody stool, severe abdominal pain, rapid weight loss and fatigue, the disease may also have many mental effects.
It is, however, often referred to as a prolonged, chronic problem with an ever increasing risk of psychological problems, stroke, as well as significant changes in the brain.
The new research
A new research published in the UEG Journal suggests that individuals with Crohn’s disease experience slower response times compared to those who don’t have the disease. In another study of Crohn’s patients, cognitive responses were significantly correlated with main symptoms of the disease, such as active inflammation, pain, fatigue and abdominal pain – the responses being 10 per cent slower than normal.
Compared to the individuals assessed over the legal drink drive in most EU countries (blood alcohol content over 0.05 g/100ml), the response times in Crohn’s patients was slower, when tested on a computer-based cognitive activity in a similar study by the same group.
The results from the studies concluded that mild cognitive impairment in Crohn’s patients and support patients is present, including frequent complaints of clouding thought, memory lapses, and difficulty in concentration.
Crohn’s ‘brain’ symptoms
Over the decades, Crohn’s disease has been considered one of the two main forms of inflammatory bowel disease alongside ulcerative colitis. As a result of heightened incidence levels in the northern and western parts of the continent, the disease has been an epidemic throughout Europe. Although there is no solitary cause for the disease, the combination of genetic and environmental factors usually make the problem extremely debilitating for the patients.
As well as the recognized bowel-related symptoms of Crohn’s disease such as abdominal pain and diarrhea, the condition has now also been shown to impact cognitive function. The ‘brain’ symptoms under Crohn’s are usually ignored by clinicians, even though patients frequently experience them. The lead researcher behind the findings, Dr. Daniel van Langenberg, said the present results reinforce the notion that with the impact of disease affecting patients, Crohn’s has a vast range of multi-systemic consequences; not only within but well beyond the digestive tract.
Langenberg adds, “The findings appear consistent with experiments that have shown that bowel inflammation results in an upregulation of inflammatory hippocampus activity in the brain.”
Additionally, UEG inflammatory bowel disease expert, Professor Gigi Veereman, comments that the research appropriately highlights the need for regular interventions with a range of multi-disciplinary IBD teams to address the issues presented with Crohn’s disease. This will greatly improve the care and service offered to each patient, enabling greater understanding of this complex condition.
Neurological symptoms associated with the Crohn’s
Crohn’s disease can affect any part of the nervous system, including the peripheral areas. Undoubtedly, early diagnosis and treatment leads to better outcomes. Many studies show that Crohn’s disease can lead to certain nervous system disorders. The good news, however, is that it doesn’t happen often.
Peripheral neuropathy is, for instance, one condition that causes nerve damage and tingling pain in the extremities. On the other hand, a condition known as polyneuropathy can lead to nerve degeneration and loss of the myelin sheath – protective coating that envelopes the nerves.
- Structural brain changes
As described in the January 2013 issue of “Neurogastroenterology & Motility,”, patients with Crohn’s disease have also been reported to have changes in the brain structure, with apparent gray reductions shown in many regions. Some of these areas are responsible for cognitive, pain, and emotional processes. The study also noticed that the reductions in the brain volumes persisted as the disease prolonged.
The belief in the relevance of psychological factors related to IBD is not a new concept. Historically speaking, it was first seen during the 1930’s that psychiatrists and gastroenterologists suggested that emotional life experiences can most likely be related to exacerbation of intestinal symptoms.
At the time, intestinal bowel disease was still considered a psychosomatic issue, and it’s relation to psychological factors was thought about so strongly that none of the researchers felt the need to use any control group in their experiments.
A few decades later, the findings were mostly questioned due to the uncontrolled concept and methodological weaknesses published in this area. For a long while, psychological influences on IBD were considered as contributing factor to the disease; an organic problem. However, further established anecdotal evidence as well as clinical observations indicated that stressful experiences could heavily affect the course of IBD.
There have been, indeed, many review articles emphasizing the relationship between IBD and stress. They suggest that the controversies and confusions in published reports was mainly due to the differences in definitions of stress (for example, daily stress or stressful life events) and partly due to mixed status of disease (active vs inactive) and inclusion of mixed groups of patients (UC vs. CD).
The major trend in the studies, therefore, was to differentiate between the CD and UC patients, utilizing the notion of perceived stress which emphasizes on the individual perception of the aspect and their emotional response to it.
According to a September 2014 report published in PloS One, patients of Crohn’s showed extreme depression and anxiety compared to people who didn’t have the disease. The possible role of chronic stress, emotional problems and mood disorders have also been associated with the disease.
However, the April 2014 study report published in the “World Journal of Gastroenterology”, notes the uncertainty that whether the psychological problems under Crohn’s are associated with the disease itself or connected to the poor quality of life hence produced.
The aforementioned trends have heavily contributed to resolving controversies, highlighting the role of psychological stress in IBD. There is no doubt that stress is an exacerbating factor in relation to the course and symptoms of the disease, even though the role of the cause in the onset of IBD hasn’t been established yet.
While it can definitely be taken as one of the main determinants, there are some discordant reports about the relation between the onset of the disease and stress. Similarly, the Li et al. follow up study was based on the same reports, describing the onset of parents who lost a child in Denmark and their negative relationship shared between psychological stress and development of IBD.
These conclusions, therefore, provided substantial support for the beliefs that in almost 75 percent of IBD patients, stress or their own personality, plays a major role in developing their disease; while in 90 percent it influences their disease activity.
Crohn’s other brain effects
Other effects on the brain caused by Crohn’s include peripheral neuropathy, characterized by damage to the peripheral nerves that connect to the rest of the body. This results in symptoms like weakness in the arms and legs, pain as well as general muscle weakness, dizziness and blurred vision.
Even though neuropathy has been previously associated with Crohn disease, a review in the February 2014 issue of the “World Journal of Gastroenterology” suggested this finding to be debatable with a few studies finding very low prevalence in individuals with Crohn’s.