Cognitive performance in irritable bowel syndrome: evidence of a stress-related impairment in visuospatial memory

P J Kennedy, G Clarke, A O'Neill, J A Groeger, E M M Quigley, F Shanahan, J F Cryan, T G Dinan, P J Kennedy, G Clarke, A O'Neill, J A Groeger, E M M Quigley, F Shanahan, J F Cryan, T G Dinan

Abstract

Background: Central nervous system (CNS) dysfunction is a prominent feature of the functional gastrointestinal (GI) disorder, irritable bowel syndrome (IBS). However, the neurobiological and cognitive consequences of key pathophysiological features of IBS, such as stress-induced changes in hypothalamic-pituitary-adrenal (HPA)-axis functioning, is unknown. Our aim was to determine whether IBS is associated with cognitive impairment, independently of psychiatric co-morbidity, and whether cognitive performance is related to HPA-axis function.

Method: A cross-sectional sample of 39 patients with IBS, a disease control group of 18 patients with Crohn's disease (CD) in clinical remission and 40 healthy age- and IQ-matched control participants were assessed using the Paired Associates Learning (PAL), Intra-Extra Dimensional Set Shift (IED) and Spatial Working Memory (SWM) tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) and a computerized Stroop test. HPA-axis function was determined by measuring the cortisol awakening response (CAR).

Results: IBS patients exhibited a subtle visuospatial memory deficit at the PAL six- pattern stage (p = 0.03), which remained after psychiatric co-morbidity was controlled for (p = 0.04). Morning cortisol levels were lower in IBS (p = 0.04) and significantly associated with visuospatial memory performance within IBS only (p = 0.02).

Conclusions: For the first time, altered cognitive function on a hippocampal-mediated test of visuospatial memory, which was related to cortisol levels and independent of psychiatric co-morbidity, has been identified in IBS. Visuospatial memory impairment may be a common, but currently neglected, component of IBS. Further elucidation of the nature of this impairment may lead to a greater understanding of the underlying pathophysiology of IBS, and may provide novel therapeutic approaches.

Figures

Fig. 1.
Fig. 1.
Group comparison of visuospatial episodic memory performance on the Paired Associates Learning (PAL) test. (a) Mean errors at the six-pattern stage [* p < 0.05, irritable bowel syndrome (IBS) versus control]; (b) mean errors at the eight-pattern stage; (c) mean total errors; (d) average trials needed to successfully complete each stage; (e) average number of correct choices on the first trial of each stage; lower score = poorer performance. CD, Crohn's disease. Data are presented as mean ± standard error of the mean (s.e.m.).
Fig. 2.
Fig. 2.
Group comparison of total morning cortisol levels determined using an area under the curve with respect to ground (AUCg) calculation on all three measurement points in healthy control participants (n = 34), patients with irritable bowel syndrome (IBS; n = 36) and patients with Crohn's disease (CD; n = 17). * p < 0.05, *** p < 0.001 versus control. Data are presented as mean ± standard error of the mean (s.e.m.).

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