An association between coeliac disease and neurological symptoms such as peripheral numbness or pain, as well as balance problems, has been noted previously in about 10% of coeliac patients, but the existence of a direct link between coeliac disease and dementia has not previously been reported.

The Mayo Clinic (US) neurologist who first suspected a possible link, searched the clinic's medical records to identify a total of 13 patients who had experienced cognitive decline within two years of the onset or worsening of coeliac disease.

The most common impairments experienced by these patients were amnesia, an inability to do simple calculations, confusion and personality changes, and such was the degree of impairment to thinking and the speed of decline in three patients that they were initially diagnosed with Creutzfeldt-Jacob disease (CJD).

Cognitive decline normally continues to worsen progressively, but two of the Mayo patients subsequently recovered mental function after being placed on a gluten-free diet. A third also showed stabilisation of mental function, once on the diet.

The connection between coeliac disease and dementia could be coincidental but, as it is almost unheard of to see a reversal in cognitive decline and, given the simultaneous appearance of the dementia and digestive symptoms in five of the patients and the fact that they were relatively young (average age 64 years) to have dementia, a chance connection is unlikely.

Preliminary theories include the possibility that the immune response to gluten may attack the brain directly, or that coeliac disease causes inflammation within the brain, which triggers dementia.

Clearly, this finding will need to be verified by further investigation, but the connection is sufficiently compelling to recommend that doctors consider the possibility of coeliac disease in patients who present with atypical forms of dementia, and that patients with coeliac disease are identified promptly and treated proactively.

Unfortunately, while coeliac disease is common, it is often misdiagnosed or missed altogether due to the frequently vague nature of the symptoms, which do not necessarily affect the gastrointestinal tract and may manifest more generally as, for example, weight loss, fatigue or anaemia.

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