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Cortical Thinning, School Problems Associated with Pediatric Crohn’s
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ORLANDO, Fla. — Two studies presented at the Advances in IBD meeting showed the potential neurological and psychological implications of treating pediatric Crohn’s disease, with these patients showing cortical thinning and more school problems than healthy counterparts.
“The potentially adverse effects of disease and treatment on brain and cognitive function carry clinical implications for the development of our young patients, particularly in the setting of recurring illness and increasingly younger ages of disease onset,” Christine Mrakotsky, PhD, assistant professor of psychology at Harvard Medical School, said during her presentation. “In short, we have to identify the patients that are at the highest risk for these cognitive brain outcomes early and begin appropriate interventions.”
Cortical thinning
In the first study presented by Mrakotsky, researchers conducted baseline MRIs, cognitive testing and bloodwork followed by cognitive testing and bloodwork after 6 months, in which patients with active Crohn’s disease received steroids for treatment.
The study looked at 12 patients with Crohn’s disease, in an acute flare and later on steroids compared to 20 age-matched healthy controls. The controls and active disease patients were similar in sex, ethnicity, income, IQ, pain rating and sleep rating.
Erythrocyte sedimentation rate (ESR) for patients with Crohn’s disease was 21.3 mm/hr, as compared to 4.8 mm/hr in the control group (P=.006) and C-reactive protein measured 1.3 mg/dL for the Crohn’s group while the control group measured 0.1 mg/dL (P=.051).
After adjusting for age and sex and correcting for various comparisons, Mrakotsky said cortical thickness was significantly thinner in the Crohn’s disease group when compared to the controls (P<.01). Reduced thickness correlated with higher steroid dose, greater inflammation and worse school function, she said.
“Steroid therapy was the most robust predictor for cortical thinning,” Mrakotsky said. “Both inflammation and steroid treatment are associated with cortical thinning, particularly in frontal and posterior temporal regions. These cortical regions play a critical role in higher cognitive and emotional processes and are potentially linked to previously reported poorer emotional and school functioning in this population. We also believe IBD-related brain differences have the potential to affect cognitive and emotional development long-term.”
Emotional, psychological impact
In another study looking at 85 children with Crohn’s disease and 37 healthy controls, Mrakotsky and colleagues assessed the rate of school problems experienced by the patients. They used school and medical history, cognitive testing and serum inflammation. Similarly to the first, a round of testing was done at baseline and again at 6 months.
“Our Crohn’s patients as a whole — both inactive and active — showed poorer cognitive function than healthy controls,” she said.
Participants with Crohn’s disease showed poorer cognitive function in verbal IQ, nonverbal IQ and full-scale IQ, though only the nonverbal was a significant difference, Mrakotsky showed. When looking at memory function, the children with Crohn’s disease, both active and in remission, showed significantly or trending poorer function in word lists and spatial function and trended toward poor performance in figure details.
Children with Crohn’s disease showed higher rates of school problems than their healthy counterparts in the following areas: reported school problems (23.5% vs. 8.1%, P=.048); placement on 504 plan (38.8% vs. 0%, P=.00); and education interventions (45.9% vs. 2.7%, P=.00). The contributing factors that were significantly different between the groups was frequent illness during infancy and missed school days; other factors such as history of surgery, developmental speech delay and family histories of learning and emotional disorders were comparable between the two groups.
“School function does correlate with cortical thickness and other brain variables,” Mrakotsky said. “While we don’t know the underlying neurobiological mechanisms quite yet, these findings carry implications for clinical recommendations for routine neuropsychological and psychological screening. If we do identify problems on these screenings, then we can argue for educational and psychological interventions in addition to medical therapies, which could include provision of special educational services … and targeted therapy for emotional problems.”
For more information:
Mrakotsky C. O-010; O-013. Presented at: 2014 Advances in Inflammatory Bowel Diseases, Dec. 4-6, 2014; Orlando, Fla.
Disclosures: Mrakotsky reports no relevant conflicts of interest. Her studies were supported by NIH and NCCR grants.