Vascular Disease Is Associated With Differences in Brain Structure and Lower Cognitive Functioning in Inflammatory Bowel Disease: A Cross-Sectional Study

Ronak Patel; Ruth Ann Marrie; Charles N Bernstein; James M Bolton; Lesley A Graff; James J Marriott; Chase R Figley; Jennifer Kornelsen; Erin L Mazerolle; Carl Helmick; Md Nasir Uddin; John D Fisk

doi:10.1093/ibd/izad204

Vascular Disease Is Associated With Differences in Brain Structure and Lower Cognitive Functioning in Inflammatory Bowel Disease: A Cross-Sectional Study

Inflamm Bowel Dis. 2023 Sep 22:izad204. doi: 10.1093/ibd/izad204. Online ahead of print.

Authors

Ronak Patel¹, Ruth Ann Marrie^{2

3}, Charles N Bernstein², James M Bolton⁴, Lesley A Graff¹, James J Marriott², Chase R Figley^{5

6

7}, Jennifer Kornelsen^{5

6

7}, Erin L Mazerolle⁸, Carl Helmick⁹, Md Nasir Uddin^{5

10

11}, John D Fisk^{9

12

13}

Affiliations

¹ Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
² Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
³ Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
⁴ Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, MB, Canada.
⁵ Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
⁶ Division of Diagnostic Imaging, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada.
⁷ PrairieNeuro Research Centre, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada.
⁸ Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada.
⁹ Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.
¹⁰ Department of Neurology, University of Rochester, Rochester, NY, USA.
¹¹ Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA.
¹² Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.
¹³ Department of Medicine, Dalhousie University, Halifax, NS, Canada.

PMID: 37740523
DOI: 10.1093/ibd/izad204

Abstract

Background: Vascular disease and cognitive impairment have been increasingly documented in inflammatory bowel disease (IBD), and both have been individually correlated with changes in brain structure. This study aimed to determine if both macro- and microstructural brain changes are prevalent in IBD and whether alterations in brain structure mediate the relationship between vascular disease and cognitive functioning.

Methods: Eighty-four IBD participants underwent multimodal magnetic resonance imaging. Volumetric and mean diffusivity measures of the thalamus, hippocampus, normal-appearing white matter, and white matter lesions were converted to age- and sex-adjusted z scores. Vascular comorbidity was assessed using a modified Framingham Risk Score and cognition was assessed using a battery of neuropsychological tests. Test scores were standardized using local regression-based norms. We generated summary statistics for the magnetic resonance imaging metrics and cognitive tests, and these were examined using canonical correlation analysis and linear regression modeling.

Results: Greater vascular comorbidity was negatively correlated with thalamic, normal-appearing white matter, and white matter lesion volumes. Higher Framingham Risk Score were also correlated with lower processing speed, learning and memory, and verbal fluency. Increased vascular comorbidity was predictive of poorer cognitive functioning, and this effect was almost entirely mediated (94.76%) by differences in brain structure.

Conclusions: Vascular comorbidity is associated with deleterious effects on brain structure and lower cognitive functioning in IBD. These findings suggest that proper identification and treatment of vascular disease is essential to the overall management of IBD, and that certain brain areas may serve as critical targets for predicting the response to therapeutic interventions.

Keywords: IBD; MRI; brain; cognition; vascular comorbidity.

Plain language summary

Vascular disease is associated with decreased cognitive performance in persons with inflammatory bowel disease, and this is mainly driven by changes in the brain, including both gray matter and white matter regions.

Grants and funding

THC-135234/CAPMC/ CIHR/Canada