The Bidirectional Relationship Between Cognitive Function and Active Inflammatory Bowel Disease

Cognitive impairment, a precursor to dementia, is an important geriatric syndrome. We aimed to describe cognitive function in adults 60 years or older with inflammatory bowel disease (IBD) and determine the relationship between cognitive function and IBD activity.

We recruited patients with IBD 60 years or older from 6 American centers. We collected demographics, IBD history, administered IBD activity indices, and the Montreal Cognitive Assessment (MoCA). Follow-up assessments were nested in routine clinical care within 1 year. The primary outcome was change in cognitive function testing at follow-up; secondary outcome was IBD activity at follow-up. We constructed multivariate logistic regression models to assess for the outcomes.

We recruited 356 patients with a median age of 70 years (range: 60-89 years), 51% female, 66% had at least a bachelor's degree; median IBD duration was 18 years, and 60% had Crohn's disease. At baseline, 42% screened positive for cognitive impairment. Deficits in delayed recall and visuospatial functioning were the most prevalent. At follow-up within a year, 31% demonstrated an improved MoCA score, while 19% had a worse MoCA score. Adjusting for age, race, education, depression, number of comorbidities, IBD type, IBD duration, and cognitive function score at baseline, symptomatically active IBD at baseline was significantly associated with worsening cognitive testing at follow-up (aOR: 3.01, 95% CI: 1.20-7.50). We also found that deficits in delayed recall, a MoCA subdomain, were significantly associated with symptomatically active IBD at follow-up (aOR: 2.22, 95% CI: 1.10-4.47).

These data provide further impetus to effectively treat IBD in older adults and suggest that delayed recall could be a useful screening tool for older adults with IBD.