What question did this study set out to answer?

To explore cognitive function in adults aged 60 and older with inflammatory bowel disease and its relationship with IBD activity.

January 23, 2026

P0204The bidirectional relationship between cognitive function and active inflammatory bowel disease

Key Points

To explore cognitive function in adults aged 60 and older with inflammatory bowel disease and its relationship with IBD activity.
Prospective recruitment of IBD patients aged ≥60 from six American centers.
Collected demographic data and administered the Montreal Cognitive Assessment (MoCA).
Follow-up assessments conducted within one year to measure cognitive function changes.
Utilized multivariate logistic regression models to analyze outcomes.
356 patients were assessed, with 42% showing cognitive impairment at baseline.
31% of participants improved their MoCA scores by ≥2 points, while 19% worsened by ≥2 points over a year.
Active IBD at baseline significantly associated with cognitive decline at follow-up (aOR:3.01).
Deficits in delayed recall at baseline were linked to active IBD at follow-up (aOR:2.22).

Abstract

Abstract Background Cognitive impairment, a precursor to dementia, is an important geriatric syndrome. We aimed to describe cognitive function in adults ≥60 years with inflammatory bowel disease (IBD) and determine the relationship between cognitive function and IBD activity. Methods We prospectively recruited IBD patients ≥60 years from 6 tertiary American centers. We collected demographics, IBD history, administered IBD activity indices and the Montreal Cognitive Assessment (MoCA). Follow-up assessments were nested in routine clinical care within one year. The primary outcome was change in cognitive function testing at follow-up; secondary outcome was IBD activity at follow-up. We constructed multi-variate logistic regression models to assess for the outcomes. Results We recruited 356 patients with a median age of 70 years (range: 60–89 years), 51% female, 66% had at least a Bachelor’s degree; median IBD duration was 18 years and 60% had Crohn’s disease. At baseline, the median MoCA score was 26 (range: 15–30); 42% screened positive for cognitive impairment. Characteristics of the cohort by cognitive impairment status at baseline are detailed in Table 1. Deficits in executive functioning were the most prevalent with only 14% scoring fully on delayed recall and 40% scoring fully on visuospatial functioning. At follow-up within a year, 31% demonstrated a MoCA score improved by ≥ 2 points, while 19% had a MoCA score worsened by ≥ 2 points (Figure 1). Adjusting for age, race, education, depression, number of comorbidities, IBD type, IBD duration as well as cognitive function score at baseline, symptomatically active IBD at baseline was significantly associated with worsening cognitive testing at follow-up (aOR:3.01, 95%CI:1.20–7.50). We also found that deficits in delayed recall, a MoCA sub-domain, were significantly associated with symptomatically active IBD at follow-up (aOR:2.22, 95%CI:1.10–4.47). Conclusion Symptomatically active IBD is significantly associated with worsening scores on cognitive function testing over 12 months. The prevalence of cognitive impairment in this cohort of older adults with IBD was greater than expected for age and education adjusted norms. The proportion of the cohort that demonstrated a worsening trajectory over one year is also greater than reports from other cohorts of older adults. We noted that delayed recall at baseline was significantly associated with symptomatically active IBD at follow up within a year. These data provide another reason for effectively treating IBD in older adults: to mitigate cognitive decline. Additional studies are needed to determine if delayed recall may be a useful screening tool to identify older adults at greater risk for active IBD References: Zhang B, Wang HE, Bai YM, et al. Inflammatory bowel disease is associated with higher dementia risk: a nationwide longitudinal study. Gut 2020;70:85-91. Kochar B, Ufere NN, Ritchie CS, et al. The 5Ms of Geriatrics in Gastroenterology: The Path to Creating Age-Friendly Care for Older Adults With Inflammatory Bowel Diseases and Cirrhosis. Clin Transl Gastroenterol 2022;13:e00445. Kowalski K, Mulak A. Brain-Gut-Microbiota Axis in Alzheimer’s Disease. Journal of Neurogastroenterology and Motility 2019;25:48-60. Hopkins CWP, Powell N, Norton C, et al. Cognitive Impairment in Adult Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. Journal of the Academy of Consultation-Liaison Psychiatry 2021;62:387-403. Conflict of interest: Dr. Kochar, Bharati: Consulting fees from Pfizer, Bristol Myers Squibb, Merck, Jansen and Takeda, all relationships ended. Faye, Adam: Consulting/Educational funding from: AbbVie, Takeda, Eli Lilly Araka, Elizabeth: No conflict of interest Glasser, Rachel: No conflict of interest Gupta, Aarushi: No conflict of interest Rusher, Alison: No conflict of interest Beniwal, Poonam: No conflict of interest Horst, Sara: Consultant for J & J, Takeda, Abbvie, Lilly, Biocon, Mirador, Celltrion. Educational Grant from Abbvie, Takeda. Herfarth, Hans: consulting fees from Celltrion, Evommune, Fresenius Kabi, Galapagos, Gilead, ExeGI, Ritchie, Christine: No conflict of interest Ananthakrishnan, Ashwin: Consultant – Geneoscopy Research Support: Takeda

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Cite This Study

Kochar et al. (Thu,) studied this question.

synapsesocial.com/papers/69730ed4c8125b09b0d1ead2 https://doi.org/https://doi.org/10.1093/ecco-jcc/jjaf231.385

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