A Prospective Study Characterizing Cognitive Function in Patients with Inflammatory Bowel Disease

INTRODUCTION: Inflammatory bowel disease (IBD) may be associated with cognitive impairment. Cognitive decline is also linked to weaker anesthesia-induced alpha wave electroencephalographic (EEG) signals. We aimed to characterize the associations between cognition and EEG alpha power in patients with IBD. METHODS: In this prospective cohort study, patients with IBD and controls undergoing diagnostic or screening colonoscopies underwent preprocedural cognitive testing using the tablet-based Brain Health Assessment (BHA), intraprocedural EEG monitoring, and follow-up testing. Primary outcomes were BHA scores and EEG alpha power. Secondary outcomes included within-participant changes in cognitive performance. RESULTS: We enrolled 40 patients with IBD and 42 control patients. Fifteen IBD patients and 17 controls completed follow-up cognitive testing 6-18 months after endoscopy. Patients with IBD were younger (mean age 42 vs. 56 years, p<0.001), more likely to screen positively for depression (p=0.004), and had fewer years of education (16.2 vs. 17.3 years, p=0.03). Fifteen IBD patients had active endoscopic inflammation. Adjusting for demographics, education level, and depression, EEG alpha power did not differ between groups. Median BHA scores indicated moderate likelihood of cognitive impairment in both groups. However, controls demonstrated improved within-participant follow-up performance (p<0.01), while IBD patients did not (p=0.16). DISCUSSION: IBD patients and controls demonstrate preprocedural cognitive impairment on BHA, but no differences in EEG alpha power. Lack of follow-up improvement in IBD patients may suggest lower baseline cognitive function while highlighting the importance of further investigations on cognition in this population.