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

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    70 Scopus citations


    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.

    Original languageEnglish (US)
    Pages (from-to)1553-1566
    Number of pages14
    JournalPsychological Medicine
    Issue number7
    StatePublished - May 2014


    • CANTAB
    • cognition
    • cortisol
    • irritable bowel syndrome (IBS)
    • stress

    ASJC Scopus subject areas

    • Psychiatry and Mental health
    • Applied Psychology


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