Does coeliac disease cause ataxia or cognitive impairment?

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Coeliac disease (CD) is due to an allergy to a protein (gluten) found in wheat, barley and rye. It classically causes disease of the small bowel, resulting in impaired absorption of important nutrients, and is treated by a restrictive diet eliminating foods containing extracts of these grains. However, it has recently been found that CD is much commoner than previously thought (about 1 in 100-200), and often causes only non-specific symptoms. Two important conditions linked to CD by some, but not all, researchers are ataxia (incoordination) and impairment of thinking and memory. The problem is that many normal people (12% of the population) have antibodies to gluten, so that studies suggesting that sensitivity to gluten, as determined by the presence of antibodies, causes these brain disorders are not conclusive. That is, this could be a chance association. Furthermore, there is some evidence that damage to the coordination part of the brain (the cerebellum) from other causes may also cause antibodies to gluten. It is quite possible that antibodies to the cerebellum can cross-react with gluten, and vice versa. In this case, treating patients with ataxia and antibodies to gluten with the restrictive diet may be treating the result rather than the cause of the disorder. This project will study patients with CD (proven on small bowel biopsy) with sensitive, objective methods, including MRI, electronic measures of coordination, and psychological tests of thinking and memory, to see whether CD really is associated with these two problems. It will also study coordination and brain structure in a mouse model of CD. If the associations are proven, all patients with these disorders will need to be tested for CD, and treated with the restrictive diet if found to be positive. If not, clinicians will be confident that testing for anti-gluten antibodies would be irrelevant and misleading in these two situations.