Irritable bowel disease could mean increased risk of dementia

Inflammatory bowel disease, which includes ulcerative colitis and Crohn’s disease, is a chronic inflammatory condition that affects more than 3 million American adults and millions more worldwide. Intermittently, it causes stomach pain, diarrhea and bloody stools.

According to the researchers, their study was the first to explore IBD as a factor of dementia.

“It’s been quite a few years since we’ve known that IBD is associated with depression and anxiety,” said Dr. Bing Zhang, a member of the gastroenterology division of the department of medicine at the University of California, San Francisco, and a co-author of The new study he published Tuesday in the journal Gut.

“In fact, we knew that 30% of people with IBD would develop these,” said Zhang. “However, it was not until recently that we began to see more neurocognitive changes and neurocognitive impairment.”

A longitudinal study

Our gut bacteria, or microbiome, is made up of bacteria, viruses, and microbes that are small but actually quite powerful; They seem to help our metabolic functions, help us protect ourselves from pathogens, and control our immune system.
IBD is believed to originate from a dysfunctional or increased immune response to changes in the microbiome of a genetically susceptible person. It could also be caused by environmental factors.
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The study analyzed 1,742 patients with IBD who were 45 years or older, selected from the Research Database of the National Taiwan Health Insurance, and compared them to more than 17,400 people without the disease.

They were tracked for up to 16 years to examine the relationship between dementia and IBD. The study was observational and did not establish cause and effect. Nor did it analyze lifestyle factors such as diet and exercise.

Participants with IBD had a 4.1% higher incidence of dementia and were diagnosed more than seven years earlier than those patients without IBD. The overall incidence of dementia was 5.5% among patients with IBD compared to 1.4% among those without IBD.

People with IBD were at increased risk for two types of dementia: Alzheimer’s dementia, which is caused by damage and death to nerve cells and affects memory, thinking, and behavior; and vascular dementia, which stems from conditions that block or reduce blood flow to the brain.

The study found that the association between IBD and dementia was the same for men and women. There was no difference in risk. among those with ulcerative colitis or Crohn’s disease, but there was an increased risk of dementia as the severity and duration of IBD increased.

According to previous studies, IBD patients who are in remission and do not experience symptoms may still have remaining inflammation. Due to those previous findings, the authors believe that both inflammation during symptoms and inflammation during remission periods could contribute to the development of dementia.

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Recent research has suggested a connection between IBD and the development of Parkinson’s disease, a progressive disorder of the nervous system that affects movement by causing tremors, stiffness, or slowdown. IBD may play a role through chronic inflammation, disruption of intestinal and blood-brain barriers, and damage to the intestinal microbiome, in addition to genetic predispositions.

The current study “added another piece of the puzzle in terms of the additional manifestations of IBD in the brain,” said Zhang.

The links between IBD and cognitive decline

One possible explanation for the association between IBD and dementia is that IBD could harm intestinal bacteria that help produce and release neurological messengers that help control inflammation, Zhang said.
“Your body may contribute to inflammation of the brain,” he added. For example, Alzheimer’s disease, the most common dementia, is accompanied by inflammation in the brain that can damage cognitive processes.
Inflammation is also linked to an increased risk of stroke, which can lead to vascular dementia that cuts off blood in the brain and thus cognitive function.
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Additionally, the research found that drugs used to treat IBD, such as anti-TNF, drugs that helped reduce inflammation, may be involved in neurodegeneration. That could explain why the risk of dementia was higher for those taking the stronger medications, the study suggested.

Several other factors may also explain the association, said Dr. Aline Charabaty Pishvaian, director of the Center for Inflammatory Bowel Disease at Sibley Memorial Hospital in Washington, DC, who was not involved in the study.

Because IBD affects nutrient absorption through the intestines, patients may have nutritional deficiencies that affect brain health. People with IBD often have higher blood markers of inflammation; In fact, previous studies found that chronic disease patients with these markers were at increased risk for brain damage and dementia.

Lack of sleep and chronic stress, which affect IBD patients, can accelerate cognitive decline, Charabaty Pishvaian said.

“If we believe that chronic inflammation, nutrient deficiencies, and chronic physical and emotional stress are possible major factors promoting cognitive decline and dementia in our IBD patients,” he said, “it is even more crucial to control inflammation in the intestine”.

An anti-inflammatory diet like the Mediterranean diet could help ease IBD symptoms, Zhang said.

Any nutritional deficiencies must be corrected, said Charabaty Pishvaian, and mental and emotional health must be evaluated, to prevent not only gastrointestinal complications but also to improve overall health.

“This is a life-long disease that requires a comprehensive and multidisciplinary approach,” he added.