B0639 - Alzheimer's Disease Occurs More Frequently in Patients With Celiac Disease: A Nationwide Population-Based Cohort Study

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

AF

Andrew Ford, MD

Cleveland Clinic Foundation
Cleveland, OH

Andrew Ford, MD¹, Manik Aggarwal, MD¹, Almaza A. Albakri, MD², Motasem Alkhayyat, MD¹, Arjun Chatterjee, MD¹, Claire Jansson-Knodell, MD¹, Alberto Rubio Tapia, MD³
¹Cleveland Clinic Foundation, Cleveland, OH; ²Royal Jordanian Medical Services, Amman, Al Karak, Jordan; ³Cleveland Clinic, Cleveland, OH

Introduction: Alzheimer disease (AD) affects greater than 5 million Americans and is increasingly prevalent among an aging population. Cognitive decline in general has been linked to chronic inflammation and altered intestinal microbiome. Celiac disease (CD) is an autoimmune enteropathy characterized by immune-mediated damage caused by exposure to gluten. This study was designed to describe the epidemiology and risk association of Alzheimer disease in patients with CD.

Methods: We surveyed a multi-institutional database (Explorys Inc., Cleveland, OH); an aggregate of electronic health record data from 26 major US health systems. Cohorts of patients with AD and CD were generated using Systemized Nomenclature of Medicine – Clinical Terms (SNOMED-CT). AD was defined as SNOMED terms for “Alzheimer’s disease” or “Alzheimer’s dementia” with prescribed Alzheimer’s treatment (donepezil, memantine, galantamine, or rivastigmine). Patients with vascular dementia or Parkinson’s disease were excluded. Univariate and multivariate analyses were performed on the data, and associations were reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs) using IBM SPSS Statistics version 25.

Results: Of 25,298,080 individuals in the database (2017-2022), 88,770 were diagnosed with celiac disease (0.35%). Among CD patients, 970 (1.1%) carried an AD diagnosis compared to 194,030 (0.8%) of the non-CD patients (p < 0.0001). After multivariate analysis, CD was associated with increased odds of Alzheimer’s disease (aOR = 5.38, 95% CI = 5.30-5.45, p < 0.0001) (Figure 1).

Discussion: This large population-based cohort study demonstrated a significantly higher odds of Alzheimer disease among celiac disease patients compared to those without celiac disease. Larger prospective work would be beneficial to identify possible mechanisms. Further work may examine possible interventions to minimize the odds of developing AD in this population and to assess the effect of gluten-free diet adherence on its development.

Figure: Risk factors for development of Alzheimer's disease

Celiac Disease	With Alzheimer’s Disease (n [%])	Without Alzheimer’s Disease (n [%])	Multivariate Analysis (aOR [95% CI])
Total	970	87800	5.38 (5.30-5.45)

Risk factor
Alcohol use	40 (4.1)	2900 (3.3)	1.01 (1.00-1.02)
Obesity	180 (18.6)	30510 (34.7)	0.53 (0.53-0.53)
Diabetes mellitus	390 (40.2)	29430 (33.5)	1.77 (1.77-1.78)
Hypertension	810 (83.5)	38880 (44.3)	8.25 (8.21-8.28)
Smoker	290 (29.9)	10460 (11.9)	1.12 (1.11-1.13)
Caucasian	890 (91.7)	71120 (81.0)	1.31 (1.31-1.32)
Senior (Age >65)	890 (91.7)	33050 (37.6)	4.18 (4.17-4.20)

Table: Baseline characteristics of patients with celiac disease

Disclosures:

Andrew Ford indicated no relevant financial relationships.

Manik Aggarwal indicated no relevant financial relationships.

Almaza Albakri indicated no relevant financial relationships.

Motasem Alkhayyat indicated no relevant financial relationships.

Arjun Chatterjee indicated no relevant financial relationships.

Claire Jansson-Knodell: Clearpoint Neuro Inc – Stock-publicly held company(excluding mutual/index funds). Dariohealth Corp Com – Stock-publicly held company(excluding mutual/index funds). DermTech Inc – Stock-publicly held company(excluding mutual/index funds). DiaMedica Therapeutics Inc. – Stock-publicly held company(excluding mutual/index funds). Exact Sciences – Stock-publicly held company(excluding mutual/index funds). Inari – Stock-publicly held company(excluding mutual/index funds). Nano-X imaging ltd – Stock-publicly held company(excluding mutual/index funds). Outset medical – Stock-publicly held company(excluding mutual/index funds). PavMed – Stock-publicly held company(excluding mutual/index funds). Transmedics Group Inc – Stock-publicly held company(excluding mutual/index funds).

Alberto Rubio Tapia indicated no relevant financial relationships.

Andrew Ford, MD¹, Manik Aggarwal, MD¹, Almaza A. Albakri, MD², Motasem Alkhayyat, MD¹, Arjun Chatterjee, MD¹, Claire Jansson-Knodell, MD¹, Alberto Rubio Tapia, MD³. B0639 - Alzheimer's Disease Occurs More Frequently in Patients With Celiac Disease: A Nationwide Population-Based Cohort Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.