An inflammatory bowel disease (IBD), Crohn’s disease (CD), which is well known for its gastrointestinal effects, also has adverse consequences on the brain.
The disease may affect an individual mentally due to its troublesome symptoms including diarrhoea, abdominal pain, weight loss and fatigue. Usually a chronic condition, it has been gravely associated with an increased risk of psychological problems and physical changes to the brain, as well as a high risk of stroke.
The ‘brain’ effects and neurological symptoms
Alongside ulcerative colitis (UC), for a long time Crohn’s disease has been widely considered as one of the two main forms of inflammatory bowel disease. The condition has rapidly spread throughout the European regions. Although there may be no solitary cause for the disease, the combination of environmental and genetic factors makes the problem extremely crippling for the patients.
Crohn’s disease has a great impact and can easily affect any part of the individual’s nervous system, including the peripheral areas of the brain. As a matter of fact, there are many established studies that show the disease leading to certain nervous system disorders. However, the good news is that it does not happen that often.
Peripheral neuropathy, for example, is one such condition that causes significant nerve damage and tingling pain in the extremities. Similarly, Polyneuropathy is another condition that can lead to potential nerve degeneration and loss of myelin sheath – a protective coating that develops nerves.
The multisystemic ‘cognitive’ consequences
Compared to the matched individuals that do not meet the criteria for the disease, Crohn’s patients experience slower response times, as concluded in the study out of SAGE and published in the UEG Journal. According to the study, along with the cognitive responses being 10 per cent slower than normal, they were significantly correlated with symptoms of active inflammation, including fatigue and abdominal pain. Interestingly, the response time was more different, slower specifically, than those individuals measured over the legal drink drive limit in most European Union countries. The study also demonstrated that the patients with Crohn’s had a poorer rating of sleep quality and higher median depression score – measurements associated with severe cognitive impairment.
According to the lead researcher, Dr. Daniel van Langenberg, these results significantly ‘reinforce the notion’ that Crohn’s disease has a wide range of multisystemic consequences; with the impact of the disease not only affecting patients within, but well beyond the digestive tract.
“The findings appear consistent with experiments that have shown that bowel inflammation results in an upregulation of inflammatory hippocampus activity in the brain. This, in turn, might account for the slower response times that were observed in the study,” Langenberg added.
The research also highlights the necessity for multi-disciplinary interventions, with Inflammatory Bowel Disease (IBD) teams asked to address wider issues related to Crohn’s. Doing so will consequently push for a greater understanding of the symptoms, improving the service and care offered to each patient, as well as enabling greater understanding of the complex condition.
The risk of stroke
Strokes have been widely reported in individuals with Crohn’s disease. A March 2014 study, published in the ‘European Journal of Internal Medicine’, noted that patients with Crohn’s disease were more likely to experience mini-strokes as compared to individuals without the condition. Another study, published in the November 2013 issue of ‘BMC Neurology’, noted that subarachnoid haemorrhaging is one of the main causes of major strokes in hospitalised individuals with Crohn’s disease. Moreover, extensive research on the topic has found an increased risk of stroke in younger individuals with Crohn’s as compared to older people.
The Crohn psychology
Many established articles emphasize the relationship shared between IBD and stress; they suggest that the controversies surrounding the two conditions in published reports were mainly due to the difference in the individuals’ definitions of stress, inclusion of mixed groups of patients (UC vs. CD), and also the mixed status of Crohn’s disease (active vs. inactive). The major aim of the studies was to differentiate between the UC and CD patients through the utilization of perceived stress, emphasizing on the individual perception on the aspect and their emotional response to it.
The PloS One published a report in September 2014, which noted that patients with Crohn’s disease showcase extreme anxiety and depression as compared to people without the disease. The issues of emotional problems, chronic stress and various mood disorders have also been associated with the condition. The April 2014 study report published in the "World Journal of Gastroenterology", however, marks the uncertainty associated with psychological problems under Crohn. According to this study, one can’t pinpoint whether the symptoms are linked to the disease itself or connected to the poor quality of life after contracting the disease.
The trends mentioned above have played a major role in highlighting psychological aspects in IBD, for example stress, heavily contributing to resolving controversies. The role of the cause in the onset of IBD has not been established yet, but there is no doubt that stress is an exacerbating factor in relation to the course and symptoms of the disease.
There are some discordant reports regarding the relationship between stress and disease onset, with the former taken as one of the main determinants of the condition. Alternatively, the follow up study by Li et al. was based on the same reports. It described the condition of diseased parents who lost their child in Denmark. The situation resulted in a negative relationship shared between the development of IBD and psychological stress.
The conclusions provided substantial evidence for the claims that in almost 5 per cent of IBD patients, it’s stress in their lives that plays a major role in developing Crohn’s disease, while in 90 per cent it influences their disease activity.
Structural and other effects on brain
A brain test may showcase other Crohn effects including peripheral neuropathy, mainly characterized by significant damage to the peripheral nerves that connect to the rest of the body. This results in symptoms causing weakness to the arms and legs, dizziness, blurred vision, as well as general muscle weakness. A review in the February 2014 issue of the "World Journal of Gastroenterology" considered this finding debatable, although neuropathy has previously been associated with Crohn’s disease, along with other studies that reported low prevalence in individuals with Crohn’s.
In patients with Crohn’s disease, there have been reported changes in the brain structure as well. As reported in the January 2013 issue of "Neurogastroenterology & Motility," compared to healthy patients, individuals with Crohn’s show reductions in gray matter volume in various regions of the brain. Some of these areas are responsible for emotional and cognitive processes. The study also found out that the more the disease is prolonged, the higher the reductions in brain volume.
Kamil Riaz Kara is an HR Professional and Inbound Marketer. He has completed his Masters in Administrative Science from the University of Karachi. Currently, he is writing on mental health, fitness and lifestyle. Visit his company blog and check the latest post on Dementia. Connect with him on LinkedIn & Twitter for more details.
by Kamil Riaz -