International Journal of Celiac Disease
ISSN (Print): 2334-3427 ISSN (Online): 2334-3486 Website: Editor-in-chief: Samasca Gabriel
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International Journal of Celiac Disease. 2015, 3(3), 77-83
DOI: 10.12691/ijcd-3-3-7
Open AccessArticle

Neuropsychiatric Features of Celiac Disease

Jacqueline M. Arnone1, and Richard P. Conti2

1Department of Nursing, Kean University, Union, NJ, USA

2School of Psychology, Kean University, Union, NJ, USA

Pub. Date: August 14, 2015

Cite this paper:
Jacqueline M. Arnone and Richard P. Conti. Neuropsychiatric Features of Celiac Disease. International Journal of Celiac Disease. 2015; 3(3):77-83. doi: 10.12691/ijcd-3-3-7


Celiac disease (CD) is a T-cell mediated genetically inherited autoimmune disease that has evolved over time. Formerly considered a pediatric disease, the rate of occurrence is now observed in individuals ranging from early childhood to senescence. Strict adherence to a gluten-free diet is the only currently available treatment for CD in order for individuals to avert future complications and malignancies. In the , the disease has shown widespread incidence and prevalence rates and affects 1% of the total population in not-at-risk groups. This number translates into 1 out of 133 people in the United States affected, making the disease almost 100 times more common than previously considered. While histological, genetic, incidence and prevalence of disease and quality of life research studies are replete in the extant literature, up until recently, neurological and psychological manifestations have also been studied among this cohort in relation to CD. Neurological conditions such as ataxia and neuropathy in CD have received the most research attention while much less attention has been paid to psychiatric conditions and cognitive functioning. The findings on cognitive functioning in CD have revolved largely around anecdotal reports and small clinical trials totaling approximately 200 patients of varying ages. Studies reporting neuropsychological test data are few and often do not include comprehensive test batteries in which to draw further conclusions on specific cognitive deficits. Larger, well-controlled studies are needed in order to form optimal diagnosis and implementation of specific support measures for individuals living with CD across the lifespan.

celiac disease gluten sensitivity neuropsychiatry

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[1]  Fasano, A., “Surprises from celiac disease,” Scientific American, 301(2). 54-61. Aug. 2009.
[2]  Chico, G.F., and Chico, M.A, “Demystifying celiac disease,” Patient Care, 39(3). 16-20. 2005.
[3]  Wagner, G., Berger, G., Sinnreich, U., Grylli, V., Schober, E., Huber, W.D., and Karwautz, A., “Quality of life in adolescents with treated celiac disease: Influence of compliance and age at diagnosis,” Journal of Pediatric Gastroenterology and Nutrition, 47. 555-561. 2005.
[4]  Fasano, A., Berti, I., Gerarduzzi, T., Not, T., Colletti, R. B., & Drago, S., and Horvath, K., “Prevalence of celiac disease in at-risk and not-at-risk groups in the United States,” Archives of Internal Medicine, 163. 286-292. 2003.
[5]  Harvard Women’s Health Watch. (2006). Celiac disease: When the body goes against the grain. Retrieved from
[6]  Anderson, R.P., Henry, M.J., Taylor, R., Duncan, E.L., Danoy, P., Costa, M.J., and Pasco, J.A., “A novel serogenetic approach determines the community prevalence of celiac disease and informs improved diagnostic pathways,” BMC Med, 11. 188. 2013.
[7]  Ciacci, C., Cirillo, M., Sollazzo, R. Savino, G. Sabbatini, F. and Mazzacca G, “Gender and clinical presentation in adult celiac disease,” Scand Journal Gastroenterol, 30(11). 1077-1081. 1995.
[8]  Guandalini, S., “A brief history of celiac disease,” Impact, 7(3). 1-2. 2007.
[9]  McCabe, M.A., Toughill, E.H., Parkhill, A.M., Bossett, M.S., Jevic, M.S., & Nye, M.L., “Celiac disease: A medical puzzle,” American Journal of Nursing, 112(10). 34-44. 2012.
[10]  Losowsky, M.S., “A history of celiac disease,” Digestive Disease, 26. 112-120. 2008.
[11]  Haas, S.V., “The value of the banana in the treatment of celiac disease,” American Journal of Diseases of Children, 28(4). 421-437. 1924.
[12]  Fasano, A., “Celiac disease: How to handle a clinical chameleon,” New England Journal of Medicine, 348(25). 2568-2570. 2003.
[13]  [13]Edwards, M., “Coeliac disease—an update.” Practice Nurse, 31(7). 1-6. 2006.
[14]  Lichtwark, I.T., Newnham, E.D., and Robinson, S.R., “Cognitive impairment in coeliac disease improves on a gluten-free diet and correlates with histological and serological indices of disease severity,” Aliment Pharmacol Ther, 40(2).160-70. 2014.
[15]  Addolorato, G., Mirijello, A., D’Angelo, C., Leggio, L., Ferrulli, A., Vonghia, L., and Gasbarrini, G., “Social phobia in coeliac disease,” Scand J Gastroenterol, 43. 410-415. 2008.
[16]  Hu, W.T., Murray, J.A., Greenaway, M.C., Parisi, J.E., and Josephs, K.A., “Cognitive impairment and celiac disease.” Archives of Neurology, 63(10). 1440-1446. 2006.
[17]  Cranney A, Zarkadas M, Graham I, Butzner, J.D. Rashid, M., Warren, R., Molloy, M., Case, S., Burrows, V., and Switzer, C., “The Canadian celiac health survey,” Digestive Diseases & Sciences, 52(4). 1087-1095. 2007.
[18]  Guandalini, S., “Exploring the iceberg,” Impact, 8(4). 1-2. 2009.
[19]  Fasano, A., “Systemic Autoimmune Disorders in Celiac Disease,” Current Opinion in Gastroenterology, 22(6). 674-679. 2006.
[20]  Fasano, A., “Leaky gut and autoimmune diseases,” Clinical Reviews in Allergy & Immunology, 42(1). 71-78. Feb. 2012.
[21]  Fasano, A., “European and North American populations should be screened for coeliac disease,” Gut, 52(2). 168-169. 2003.
[22]  Nelson, D.A., “Gluten-sensitive enteropathy (celiac disease): More common than you think,” American Family Physician, 66(12). 2259-2266. 2002.
[23]  Anderson, R.P., “Coeliac disease: Current approach and future prospects,” Internal Medicine Journal, 38(10). 790-799. 2008.
[24]  Achkar E., Carey, W.D, Petras, R., Sivak, M.V, and Revta, R., “Comparison of suction capsule and endoscopic biopsy of the small bowel mucosa,” Gastrointestinal Endoscopy, 32. 278-281. 1986.
[25]  Freeman, H.J., “Neurological disorders in adult celiac disease,” Canadian Journal of Gastroenterology & Hepatology, 22. 909-911. 2008.
[26]  Presutti, R.J., Cangemi, J.R., Cassidy, H.D., and Hill, D.A., “Celiac disease,” American Family Physician ,76(12). 1795-1802. 2007.
[27]  Ford, R.P.K., “The gluten syndrome: A neurological disease,” Medical Hypotheses, 73. 438-440. 2009.
[28]  Bushara, K.O., “Neurologic presentation of celiac disease,” Gastroenterology, 128. S92-S97. 2005.
[29]  Chin, R.L., Latov, N., Green, P.H., Brannagan, T.H., Alaedini, A., and Sander, H.W., “Neurologic complications of celiac disease,” Journal of Clinical Neuromuscular Disease, 5. 129-137. 2004.
[30]  Hernández-Lahoz C, Mauri-Capdevila G, Vega-Villar J, and Rodrigo L., “Neurological disorders associated with gluten sensitivity,” Reviews Neurology, 53. 287-300. 2011.
[31]  Jackson, J.R., Eaton, W.W., Cascella, N.G., Fasano, A., & Kelly, D.L., “Neurologic and psychiatric manifestations of celiac disease and gluten sensitivity,” Psychiatric Quarterly, 83. 91-102. 2012.
[32]  Zelnik, N., Pacht, A., Obeid, R., and Lerner, A., “Range of neurologic disorders in patients with celiac disease,” Pediatrics, 113(6). 1672-1676. 2004.
[33]  Ghazal, F.A., Singh, S., Yaghi, S., and Keyrouz, S.G., “Gluten ataxia: An important treatable etiology of sporadic ataxia,” International Journal of Neuroscience, 122. 545-546. 2012.
[34]  Cooke, W.T., and Smith, W.T., “Neurological disorders associated with adult celiac disease,” Brain, 89. 683-722. 1966.
[35]  Fasano, A., “Celiac disease: How to handle a clinical chameleon,” New England Journal of Medicine, 348(25). 2568-2570. 2003.
[36]  Hadjivassiliou, M., Grünewald, R.A., Chattopadhyay, A.K., Davies-Jones, G.A., Gibson, A., and Jarratt, J.A., “Clinical, radiological, neurophysiological, and neuropathological characteristics of gluten ataxia,” Lancet, 352(9140). 1582-1585. 1998.
[37]  Burk, K., Bosch, S., Muller, C.A., Melms, A., Zuhlke, C., Stern, M., and Dichgans, J., “Sporadic cerebellar ataxia associated with gluten sensitivity,” Brain, 124. 1013-1019. 2001.
[38]  Green, P.H., Alaedini, A., Sander, H.W., Brannagan, T.H., Latov, N., and Chin, R.L., “Mechanisms underlying celiac disease and its neurologic manifestations,” Cellular and Molecular Life Sciences, 62(7-8). 791-799. 2005.
[39]  Bhatia, K.P., Brown, P., Gregory, R., Lennox, G.G., Manji, H., Thompson, P.D., Ellison, D.W., and Marsden, C.D., “Progressive myoclonic ataxia associated with coeliac disease: The myoclonus is of cortical origin, but the pathology is in the cerebellum,” Brain, 118. 1087-1093. 1995.
[40]  Hadjivassiliou, M., Grünewald, R.A., and Sharrack, B., “Gluten ataxia in perspective: Epidemiology, genetic susceptibility and clinical characteristics,” Brain, 126. 685-691. 2003.
[41]  Hadjivassiliou, M., Aeschlimann, P., Strigun, A., Sanders, D.S., Woodroofe, N.M., and Aeschlimann, D., “Autoantibodies in gluten ataxia recognize a novel neuronal transglutaminase,” Annals Of Neurology, 64(3). 332-343. Sep. 2008.
[42]  Hadjivassiliou, M., Maki, M., Sanders, D.S., Williamson, C.A., Grünewald, R.A., Woodroofe, N.M., and Korponay-Szabó, I.R., “Autoantibody targeting of brain and intestinal transglutaminase in gluten ataxia,” Neurology, 66(3). 373-377. Feb. 2006.
[43]  Hadjivassiliou, M., Davies-Jones, G. A., Sanders, D.S., and Grünewald, R.A., “Dietary treatment of gluten ataxia,” Journal of Neurology, Neurosurgery, and Psychiatry, 74(9). 1221-1224. Sep. 2003.
[44]  Hadjivassiliou, M., Grunewald, R. A., and Davies-Jones, G. A., “Gluten sensitivity as a neurological illness,” Journal of Neurology, Neurosurgery, and Psychiatry, 72(5). 560-563. 2002.
[45]  Cicarelli, G., Della Rocca, G., Amboni, M., Ciacci, C., Mazzacca, G., Filla, A., and Barone, P., “Clinical and neurological abnormalities in adult celiac disease,” Neurological Sciences, 24(5). 311-317. 2003.
[46]  Chin, R.L., Sander, H.W., and Brannagan, T.H., “Celiac neuropathy,” Neurology, 60. 1581-1585. 2003.
[47]  Hadjivassiliou, M., Chattopadhyay, A.K., Davies‐Jones, G.A.B., Gibson, A., Grünewald, R.A., and Lobo, A.J., “Neuromuscular disorder as a presenting feature of coeliac disease,” Journal of Neurology, Neurosurgery, and Psychiatry, 63(6). 770-775. Dec. 1997.
[48]  Chin, R.L., and Latov, N., “Peripheral neuropathy and celiac disease,” Current Treatment Options in Neurology, 7(1). 43-48. 2005.
[49]  Lerner, A., Makhoul, B. F., and Eliakim, R., “Neurological manifestations of celiac disease in children and adults,” European Neurological Journal, 4. 15-20. 2012.
[50]  Hadjivassiliou, M., Rao, D.G., Wharton, S.B., Sanders D.S., Grünewald, R.A., and Davies-Jones, A.G., “Sensory ganglionopathy due to gluten sensitivity,” Neurology, 75(11). 1003-1008. 2010.
[51]  Kaplan, J.G., Pack, D., Horoupian, D., DeSouza, T., Brin, M., and Schaumburg, H., “Distal axonopathy associated with chronic gluten enteropathy: A treatable disorder,” Neurology, 38. 642-645. 1988.
[52]  Polizzi, A., Finocchiaro, M., Parano, E., Pavone, P., Musumeci, S., and Polizzi A., “Recurrent peripheral neuropathy in a girl with celiac disease,” Journal of Neurology, Neurosurgery, & Psychiatry, 68(1).104-105. 2000.
[53]  Luostarinen, L., Himanen, S.L., Luostarinen, M., Collin, P., and Pirttila, T., “Neuromuscular and sensory disturbances in patients with well treated coeliac disease,” Journal of Neurology, Neurosurgery, & Psychiatry, 74. 490-494. 2003.
[54]  Simonati, A., Battistella, P.A., Guariso, G., Clementi, M., and Rizzuto, N., “Coeliac disease associated with peripheral neuropathy in a child: a case report,” Neuropediatrics, 29. 155-158. 1998.
[55]  Cronin, C.C., Jackson, L.M., and Feighery, “Celiac disease and epilepsy,” Quarterly Journal of Medicine, 91. 303-308. 1998.
[56]  Gobbi, G., “Coeliac disease, epilepsy and cerebral calcifications,” Brain Development, 27(3). 189-200. Apr. 2005.
[57]  Chapman, R.W., Laidlow, J.M., Colin-Jones, D., Eade, O.E., and Smith, C.L., “Increased prevalence of epilepsy in celiac disease,” British Medical Journal, 2(6132). 250-251. 1978.
[58]  Holmes, G.K.T., “Non-malignant complications of coeliac disease,” Acta Paediatrica Supplement, 412. 68-75. May. 1996.
[59]  Lionetti, E., Francavilla, R., Pavone, P., Pavone, L., Francavilla, T., Pulvirenti, A., Giugno, R., and Ruggieri, M., “The neurology of coeliac disease in childhood: what is the evidence? A systematic review and meta-analysis,” Developmental Medicine & Child Neurology, 52. 700-707. 2010.
[60]  Ludvigsson, J.F., Zingone, F., Tomson, T., Ekbom, A., and Ciacci, C., “Increased risk of epilepsy in biopsy-verified celiac disease: A population-based cohort study,” Neurology, 78. 1401-1407. 2012.
[61]  Emami, M.H., Karimi, S., Kouhestani, S., Hashemi, M., Taheri, H., “Diagnostic accuracy of IgA anti-tissue transglutaminase in patients suspected of having coeliac disease in Iran,” Journal of Gastrointestinal and Liver Diseases,17. 141-146. 2008.
[62]  Pratesi, R., Gandolfi, L., Martins, R.C., Tauil, P.L., Nobrega, Y.K., and Teixeira, W.A., “Is the prevalence of celiac disease increased among epileptic patients?” Arquivos de Neuro-Psiquiatria, 61. 330-334. 2003.
[63]  Gabrielli, M., Cremonini, F., Fiore, G., Addolorato, G., Padalino, C., Candelli, M., De Leo, M.E., Santarelli, L., Giacovazzo, M., Gasbarrini, A., Pola, P., Gasbarrini, A., “Association between migraine and celiac disease: results from a preliminary case control and therapeutic study,” American Journal of Gastroenterology, 98. 625-629. 2003.
[64]  Kalaydjian, A.E., Eaton, W., Cascella, N., and Fasano, A., “The gluten connection: The association between schizophrenia and celiac disease,” Acta Psychiatrica Scandinavica, 113. 82-90. 2006.
[65]  Dohan, F.C., “Wartime changes in hospital admissions for schizophrenia: A comparison of admission for schizophrenia and other psychoses in six countries during World War II,” Acta Psychiatrica Scandinavica, 42. 1-23. 1966.
[66]  Dohan, F.C., “Wheat consumption and hospital admissions for schizophrenia during World War II. A preliminary report,” American Journal of Clinical Nutrition, 18. 7-10. 1966.
[67]  Dohan, F.C., Grasberger, J.C., Lowell, F.M., Johnston, H.T., and Arbegast, A.W., “Relapsed schizophrenics: More rapid improvement on a milk- and cereal-free diet,” British Journal of Psychiatry, 115. 595-596. 1969.
[68]  Dohan, F.C., and Grasberger, J.C., “Relapsed schizophrenics: Earlier discharge from the hospital after cereal-free, milk-free diet,” American Journal of Psychiatry, 130. 685-688. 1973.
[69]  Dohan, F.C., Harper, E.H., Clark, M.H., Rodriguez, R.B., and Zigas, V., “Is schizophrenia rare if grain is rare?” Biological Psychiatry, 19. 383-399. 1984.
[70]  Cascella, N.G., Kryszak, D., Bhatti, B., Gregory, P., Kelly, D.L., and Mc Evoy, J.P., “Prevalence of celiac disease and gluten sensitivity in the United States clinical antipsychotic trials of intervention effectiveness study population,” Schizophrenia Bulletin, 37. 94-100. 2011.
[71]  Jin, S.Z., Wu, N., Xu, Q., Zhang, X., Ju, G.Z., Law, M.H., and Wei, J., “A study of circulating gliadin antibodies in schizophrenia among a Chinese population,” Schizophrenia Bulletin, 38(3). 514-518. 2012.
[72]  Reichelt, K.L., and Landmark, J., “Specific IgA antibody increases in schizophrenia,” Biological Psychiatry, 37. 410-413. 1995.
[73]  Carta, M.G., Hardoy, M.C., Boi, M.F., Mariotti, S., Carpiniello, B., and Usai, P., “Association between panic disorder, major depressive disorder and celiac disease: A possible role of thyroid autoimmunity,” Journal of Psychosomatic Research, 53. 789-793. 2002.
[74]  Addolorato, G., Mirijello, A., D’Angelo, C., Leggio, L., Ferrulli, A., Vonghia, L., and Gasbarrini, G., “Social phobia in coeliac disease,” Scandinavian Journal of Gastroenterology, 43. 410-415. 2008.
[75]  Addolorato, G., Capristo, E., Ghittoni, G., Valeri, C., Masciana, R., and Ancona, C., “Anxiety but not depression decreases in coeliac patients after one-year gluten-free diet: A longitudinal study,” Scandinavian Journal of Gastroenterology, 36. 502-506. 2001.
[76]  Hauser, W., Janke, K.H., Klump, B., Gregor, M., and Hinz, A., “Anxiety and depression in adult patients with celiac disease on a gluten-free diet,” World Journal of Gastroenterology, 16. 2780-2787. 2010.
[77]  Ludvigsson, J.F., Reutfors, J., Osby, U., Ekbom, A., and Montgomery, S.M., “Coeliac disease and risk of mood disorders—a general population-based cohort study,” Journal of Affective Disorders, 99. 117-126. 2007.
[78]  Ruuskanen, A., Kaukinen, K., Collin, P., Huhtala, H., Valve, R., and Maki, M., “Positive serum antigliadin antibodies without celiac disease in the elderly population: Does it matter?” Scandinavian Journal of Gastroenterology, 45. 1197-1202. 2010.
[79]  Corvaglia, L., Catamo, R., Pepe, G., Lazzari, R., and Corvaglia, E., “Depression in adult untreated celiac subjects: Diagnosis by the pediatrician,” American Journal of Gastroenterology, 94. 839-843. 1999.
[80]  Pynnönen, P.A., Isometsä, E.T., Verkasalo, M.A., Savilahti, E., and Aalberg, V.A., “Untreated celiac disease and development of mental disorders in children and adolescents,” Psychosomatics, 43(4). 331-334. 2002.
[81]  Pynnönen, P.A., Isometsä, E.T., Verkasalo, M.A., Kähkönen, S.A., Sipilä, I. Savilahti, E., and Aalberg, V.A., “Gluten-free diet may alleviate depressive and behavioural symptoms in adolescents with coeliac disease: a prospective follow-up case-series study,” BMC Psychiatry, 5. 14. 2005.
[82]  Smith, D. F., & Gerdes, L. U., “Meta-analysis on anxiety and depression in adult celiac disease,” Acta Psychiatrica Scandinavica, 125(3), 189-193. 2012. doi:10.1111/j.1600-0447.2011.01795.x
[83]  Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Washington, DC, American Psychiatric Association, 2013.
[84]  Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.
[85]  Collin, P., Pirttila, T., Nurmikko, T., Somer, H., Erila, T., and Keyrilainen, O., “Celiac disease, brain atrophy, and dementia,” Neurology, 4. 372-375. 1991.
[86]  Kinney, H.C., Burger, P.C., Hurwitz, B.J. Hijmans, J.C. and Grant, J.P., “Degeneration of the central nervous system associated with celiac disease,” Journal of the Neurological Sciences, 53(1). 9-22. 1982.
[87]  Lurie, Y., Landau, D.A., Pfeffer, J., and Oren, R., “Celiac disease diagnosed in the elderly,” Journal of Clinical Gastroenterology, 42(1). 59-61. 2008.
[88]  Frisoni, G.B., Carabellese, N., Longhi, M., Geroldi, C., Bianchetti, A., Govoni, S., Cattaneo, R., and Trabucchi, M., “Is celiac disease associated with Alzheimer’s disease?” Acta Neurologica Scandinavica, 95(3). 147-151. 1997.
[89]  Casella, S., Zanini, B., Lanzarotto, F., Caselani, F., Magni, A., Romanelli, G., and Lanzini, A., “Neuropsychological pattern during gluten free diet (GFD) in elderly coeliac patients,” Gut, 60. A86. 2011.
[90]  Luostarinen, L., Pirttilä, T., and Collin, P., “Coeliac disease presenting with neurological disorders,” European Neurology, 42(3), 132-135. 1999.
[91]  Hallert, C., and Astrom, J., “Intellectual ability of adults after lifelong intestinal malabsorption due to celiac disease,” Journal of Neurology, Neurosurgery, and Psychiatry, 46(1), 87-89. 1983.
[92]  Volta, U., De Giorgio, R., Petrolini, N., Stangbellini, V., Barbara, G., Granito, A., DePonti, F., Corinaldesi, R, and Bianchi, F.B., “Clinical findings and anti-neuronal antibodies in coeliac disease with neurological disorders,” Scandinavian Journal of Gastroenterology, 37(11). 1276-1281. Nov. 2002.
[93]  Urban-Kowalczyk, M., Smigielski, and Gmitrowicz, A., “Neuropsychiatric symptoms and celiac disease,” Neuropsychiatric Disease and Treatment, 10. 1961-1964. 2014.
[94]  Pavone, L., Mazzone, D., Incorpora, G., Drago, F., and Bottaro, G., “Cognitive disturbances in children with coeliac disease,” In G. Gobbi, F. Andermann, S. Naccarato, G. Banchini, Eds. Epilepsy and other neurological disorders in coeliac disease. London, England: Libbey. 1997, 291-293.