Attentional variability as a cognitive marker of clinical activity in Crohn's disease

Behavioral and cognitive manifestations have been increasingly recognized in Crohn disease (CD), yet the specific behavioral domains associated with clinical activity remain incompletely characterized. Although reduced response speed has been proposed as a key feature, moment-to-moment fluctuations in performance may better capture behavioral instability related to systemic inflammation. We examined behavioral variability and attentional performance in CD and their relationship with clinical activity.

In this case-control study, patients with CD of at least 1 year's duration (n = 31) and healthy controls (n = 37) completed a short, computerized attention test assessing sustained-attention, focused-attention, inhibitory control, and processing speed. Group differences were evaluated using multivariate and univariate analyses of covariance. Binary logistic regression evaluated the discriminative ability of attentional measures, while correlations and regression analyses examined associations with disease activity measured by the Harvey-Bradshaw Index (HBI).

Fifty percent of patients with CD were in clinical remission. Compared with controls, patients with CD demonstrated significantly greater attentional variability and higher omission error rates, whereas mean response speed did not differ significantly. Within the CD cohort, sustained attention was significantly associated with disease activity and was the only subdomain predicting HBI scores. Patients in clinical remission continued to show impairments in sustained and focused attention compared with controls, whereas response speed was unaffected.

CD is associated with selective alterations in attentional stability rather than generalized slowing. Attentional variability tracks clinical activity and remains detectable during remission, suggesting that sustained attention may represent a sensitive cognitive marker of ongoing disease impact.