Abstract
Psychological factors and comorbidities play an important role in inflammatory bowel diseases. Such comorbidity could be associated with a specific neural phenotype. Brain regions associated with emotion regulation and self-referential processing, including areas assigned to the “default mode network” (DMN), could be promising candidates in this regard. We investigated the functional integrity of multiple intrinsic neural networks in remitted patients with Crohn’s disease (CD) and sought to establish relationships between neural network connectivity and psychiatric symptoms. Fifteen CD patients in remission and 14 controls were investigated. We employed resting-state functional magnetic resonance imaging (fMRI) at 3 Tesla followed by a spatial Independent Component Analysis for fMRI data. Abnormal connectivity in CD patients was observed in DMN subsystems only (p < 0.05, cluster-corrected). Increased connectivity was found in the anterior cingulate and left superior medial frontal gyrus (aDMN) and the middle cingulate cortex (pDMN). Middle cingulate activity showed a significant association with anxiety scores in patients (p = 0.029). This study provides first evidence of selectively disrupted intrinsic neural network connectivity in CD and suggests abnormalities of self-referential neural networks. An increased sensitivity to self-related affective and somatic states in CD patients could account for these findings and explain a higher risk for anxiety symptoms.
Highlights
Inflammatory bowel diseases (IBD) were considered classical “psychosomatic” disorders until the second half of the 20th century, when the concept of an autoimmune background emerged
In line with the extant data suggesting an involvement of default mode network (DMN) function in irritable bowel syndrome (IBS), and given the chronicity of IBD with respect to recurrent pain burden, the higher incidence of psychological factors and the therapeutic significance of stress reduction in a majority of patients with IBD as well as symptom similarities between IBS and IBD, we predicted that Crohn’s disease (CD) patients in full remission would show altered DMN function in anterior cingulate and medial prefrontal regions compared to healthy controls
Given that cognitive dysfunction has been documented in individuals with IBD/CD and seems to be influenced by factors like depression or rumination in these patients[5, 6, 30], we expected that frontoparietal networks, i.e. systems previously related to goal-directed behavior, attention and executive function[20], would show abnormal lateral prefrontal connectivity in CD patients compared to healthy controls
Summary
Inflammatory bowel diseases (IBD) were considered classical “psychosomatic” disorders until the second half of the 20th century, when the concept of an autoimmune background emerged. Driven by the extant evidence suggesting regionally confined brain activity changes in individuals with IBD, we focused on distinct networks associated with self-referential processing and self-regulation (i.e. DMN) on the one hand and frontoparietal systems which have been previously associated with higher order cognition (such as executive function or working memory) and comprise areas along the intraparietal sulcus and dorsal premotor cortex on the other hand[18, 20]. We sought to investigate potential associations between brain activity and clinically relevant measures such as anxiety, depression, fatigue and cognitive function in order to determine a possible neuronal phenotype of CD patients with specific disease-related psychological symptoms
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