Neuropsychiatric features of celiac disease

Abstract

Celiac disease (CD) is a T-cell mediated genetically inherited autoimmune disease that has evolved over time. Formerly considered a pediatric disease, the rate of occurrence is now observed in individuals ranging from early childhood to senescence. Strict adherence to a gluten-free diet is the only currently available treatment for CD in order for individuals to avert future complications and malignancies. In the United States, the disease has shown widespread incidence and prevalence rates and affects 1% of the total population in not-at-risk groups. This number translates into 1 out of 133 people in the United States affected, making the disease almost 100 times more common than previously considered. While histological, genetic, incidence and prevalence of disease and quality of life research studies are replete in the extant literature, up until recently, neurological and psychological manifestations have also been studied among this cohort in relation to CD. Neurological conditions such as ataxia and neuropathy in CD have received the most research attention while much less attention has been paid to psychiatric conditions and cognitive functioning. The findings on cognitive functioning in CD have revolved largely around anecdotal reports and small clinical trials totaling approximately 200 patients of varying ages. Studies reporting neuropsychological test data are few and often do not include comprehensive test batteries in which to draw further conclusions on specific cognitive deficits. Larger, well-controlled studies are needed in order to form optimal diagnosis and implementation of specific support measures for individuals living with CD across the lifespan.