TOPLINE:

A notable proportion of older adults with inflammatory bowel disease (IBD) screened positive for cognitive impairment at baseline in this longitudinal cohort study. Symptomatically active IBD was associated with threefold higher odds of worsening cognitive function, whereas deficits in delayed recall were associated with a more than twofold increased risk for active IBD.

METHODOLOGY:

• Cognitive impairment is a key geriatric syndrome and an early indicator of dementia in older adults. Despite the growing population of older adults with IBD, the link between IBD and cognitive decline remains largely unexplored.
• Researchers conducted a longitudinal cohort study across six tertiary referral centers in the US to evaluate cognitive function in older adults aged 60 years or older with IBD and to examine the relationship between cognitive function and disease activity.
• Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) tool, which covers six key domains: executive function, visuospatial ability, memory (delayed recall), attention, language, and orientation. Disease activity in IBD was measured using the modified Harvey-Bradshaw Index for Crohn’s disease and the Simple Clinical Colitis Activity Index for ulcerative colitis.
• The primary outcome was the change in cognitive function testing over time, and the secondary outcome was IBD activity at follow-up visits; follow-up assessments were conducted at 6 and 12 months after baseline assessment, nested within routine clinical care.
• Cognitive change was assessed by comparing baseline and 1-year follow-up MoCA scores; a decrease of ≥ 2 points in the score indicated worsening of cognitive function, and an increase of ≥ 2 points indicated improvement.

TAKEAWAY:

• Among 356 patients with IBD (median age, 70 years; 51% female; 60% with Crohn’s disease), 42% screened positive for cognitive impairment; deficits in delayed recall and visuospatial function were most prevalent.
• Over the follow-up period, 31% of patients showed improvement in cognitive function (≥ 2-point increase in MoCA scores), and 19% showed worsening of cognitive function (≥ 2-point decrease in MoCA scores).
• After adjustment for key covariates, symptomatically active IBD at the baseline was significantly associated with a worsening cognitive trajectory at the follow-up (odds ratio [OR], 3.01; P = .018).
• Conversely, deficits in delayed recall at the baseline were independently associated with symptomatically active IBD at the follow-up (OR, 2.22; P = .026).

IN PRACTICE:

“Flagging those older adults who have delayed recall in GI [gastroenterology] clinic can help providers caring for these patients provide more granular instructions, arrange for closer follow-up or more frequent remote check-ins for medication adherence to see if there may be ways of mitigating the active disease at follow-up,” the authors of the study wrote.

SOURCE:

The study was led by Bharati Kochar, MD, MS, Division of Gastroenterology, Massachusetts General Hospital, Boston. It was published online in the American Journal of Gastroenterology.

LIMITATIONS:

The MoCA tool provided only screening-level information, limiting detailed assessment of specific cognitive domains in older adults with IBD. The study relied primarily on C-reactive protein as the objective marker of inflammation. Additionally, the cohort’s high educational attainment may have reduced the generalizability of the findings to broader populations.

DISCLOSURES:

The study received funding from the Crohn’s & Colitis Foundation Clinical Research Alliance and the National Institute on Aging. Several authors reported receiving consulting fees, educational honoraria, or research support from or serving as consultants for various pharmaceutical and healthcare companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.