Cognitive performance is impaired in coeliac patients on gluten free diet: a case-control study in patients older than 65 years of age

Dig Liver Dis. 2012 Sep;44(9):729-35. doi: 10.1016/j.dld.2012.03.008. Epub 2012 Apr 7.


Introduction: Retrospective studies and case reports suggest an association between coeliac disease and impaired cognitive function.

Aim: To evaluate functional and cognitive performances in coeliac disease vs. control patients older than 65 years.

Method: Eighteen coeliac disease patients (75±4 years, group A) on gluten free diet since 5.5±3 years and 18 age-sex matched controls (76±4 years, group B) were studied using a battery of neuropsychological tests. Results of functional and cognitive tests are expressed as "row scores" and as "equivalent scores" by relating "raw scores" to reference rank categories.

Results: Barthel Index of functional performance was similar in the 2 groups. "Raw score" was significantly lower in coeliac disease than controls for Mini Mental Test Examination (p=0.02), Trail Making Test (p=0.001), Semantic Fluency (p=0.03), Digit Symbol Test (p=0.007), Ideo-motor apraxia (p<0.001) and Bucco-facial apraxia (p<0.002). "Equivalent score" was also lower in coeliac disease than controls for Semantic memory (p<0.01) and for Ideo-motor apraxia (p=0.007).

Conclusion: Cognitive performance is worse in elderly coeliac disease than control patients, despite prolonged gluten avoidance in coeliacs. Awareness on the increasing phenomenon of late-onset coeliac disease is important to minimize diagnostic delay and prolonged exposure to gluten that may adversely and irreversibly affect cognitive function.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antibodies / blood
  • Apraxia, Ideomotor / etiology
  • Apraxia, Ideomotor / psychology
  • Apraxias / etiology*
  • Apraxias / psychology
  • Attention
  • Case-Control Studies
  • Celiac Disease / complications
  • Celiac Disease / diet therapy*
  • Celiac Disease / psychology*
  • Cognition*
  • Diet, Gluten-Free*
  • Female
  • GTP-Binding Proteins
  • Humans
  • Male
  • Protein Glutamine gamma Glutamyltransferase 2
  • Reaction Time
  • Retrospective Studies
  • Trail Making Test
  • Transglutaminases / immunology


  • Antibodies
  • Protein Glutamine gamma Glutamyltransferase 2
  • Transglutaminases
  • GTP-Binding Proteins