Cerebral magnetic resonance imaging in quiescent Crohn’s disease patients with fatigue

Table 1 Demographic characteristics

	CD patients (n = 20)	Controls (n = 17)	P value
Age (yr) at inclusion, mean ± SD	30.1 ± 6.2	28.5 (6.7)	0.460
Female, n (%)	17 (85.0)	13 (76.5)	0.680
HBI score, mean ± SD1	2.2 ± 1.1	-	-
Age of IBD onset (yr), mean ± SD	21.4 ± 5.7	-	-
IBD disease duration (yr), mean ± SD	8.8 ± 7.2	-	-
Smoker, n (%)	11 (55.0)	4.0 (23.5)	0.400
VAS, mean ± SD	7.4 (1.3)	3.4 (2.3)	< 0.001
MFI, mean ± SD	66.1 (13.3)	36.4 (10.3)	< 0.001
General Fatigue	16.4 (2.8)	8.9 (3.3)	< 0.001
Physical Fatigue	14.4 (3.0)	6.2 (2.2)	< 0.001
Mental Fatigue	12.8 (4.1)	7.2 (2.9)	< 0.001
Reduced Activity	10.7 (3.5)	6.9 (2.7)	< 0.001
Reduced Motivation	12.0 (3.6)	7.1 (2.7)	< 0.001
Education level, n (%)			0.001
Lowa	4 (20)	-
Intermediateb	10 (50)	2 (11.8)
Highc	6 (30)	15 (88.2)
Montreal classification
Location CD, n (%)
L1 ileal	3 (15.0)	-	-
L2 colonic	2 (10.0)	-	-
L3 ileocolonic	15 (75.0)	-	-
L4 upper	-	-	-
L1-3 + L4	-	-	-
Behaviour CD, n (%)
B1 non-stricturing/penetrating	15 (75.0)	-	-
B2 stricturing	3 (15.0)	-	-
B3 penetrating	2 (10.0)	-	-
+ Perianal disease	3 (15.0)	-	-
Medication use, n (%)
Immunosuppressive drugs (Aza/6MP)	12 (60.0)	-	-
None	8 (40.0)	-	-

¹HBI missing of 1 Crohn’s disease (CD) patient.

^aLow: primary education (elementary school) and lower secondary education (preparatory secondary education);

^bIntermediate: higher secondary education (higher general continued education, pre-university secondary education) and postsecondary education (intermediate vocational education);

^cHigh: tertiary education (higher professional education, university). To correct for multiple testing, the level of significance was set at P < 0.01 for the MFI score. HBI: Harvey Bradshaw Index; VAS: Visual Analogue Scale; MFI: Multidimensional fatigue index.

Table 2 Group mean subcortical structure volumes as percentage of the total brain volume in Crohn’s disease patients and controls

	CD patients (n = 20)	Controls (n = 17)	P value
Left Accumbens	0.04 ± 0.01	0.04 ± 0.01	0.56
Left Amygdala	0.09 ± 0.01	0.09 ± 0.01	0.61
Left Caudate	0.24 ± 0.02	0.24 ± 0.02	0.94
Left Hippocampus	0.27 ± 0.02	0.27 ± 0.03	0.94
Left Pallidus	0.13 ± 0.01	0.12 ± 0.01	0.32
Left Putamen	0.33 ± 0.02	0.32 ± 0.03	0.24
Left Thalamus	0.54 ± 0.02	0.54 ± 0.03	0.94
Right Accumbens	0.04 ± 0.00	0.03 ± 0.01	0.08
Right Amygdala	0.08 ± 0.01	0.09 ± 0.01	0.08
Right Caudate	0.25 ± 0.03	0.25 ± 0.02	0.76
Right Hippocampus	0.26 ± 0.02	0.27 ± 0.03	0.22
Right Pallidus	0.12 ± 0.01	0.13 ± 0.01	0.30
Right Putamen	0.31 ± 0.08	0.32 ± 0.02	0.56
Right Thalamus	0.53 ± 0.02	0.52 ± 0.03	0.48

Mean in % ± SD. CD: Crohn’s disease.

Table 3 Mean metabolite ratio to total creatine

	CD patients (n = 9)	Controls (n = 9)	P value
Ratio Glu:tCr	0.76 ± 0.12	0.84 ± 0.10	0.19
Ratio Cho:tCr	0.29 ± 0.02	0.29 ± 0.04	0.81
Ratio Ins:tCr	0.66 ± 0.08	0.70 ± 0.10	0.38
Ratio NAA:tCr	1.31 ± 0.12	1.27 ± 0.09	0.44
Ratio NAA + NAAG:tCr	1.59 ± 0.18	1.56 ± 0.13	0.69
Ratio Glu + Gln:tCr	0.92 ± 0.13	1.10 ± 0.14	0.02

Mean metabolite ratio to tCr in mmol ± SD. CD: Crohn’s disease; tCr: Total Creatine; Glu: Glutamate; Cho: Choline; Ins: Insulin; NAA: N-Acetyl Aspartate; NAAG: N-Acetyl Aspartate Glutamate; Gln: Glutamine.

Table 4 Mental status

	CD patients (n = 20)	Controls (n = 17)	P value
Global cognitive functioning
MMSE (total score), mean ± SD	28.9 (1.62)	29.65 (0.49)	0.87
Memory
Verbal
WMS memory quotient, mean ± SD3	109.2 (10.5)	115.7 (8.7)	0.72
Non verbal
WMS visual reproduction (total score), mean ± SD3	11.6 (2.7)	12.9 (2.2)	0.75
WAIS-R Digit Span forward, mean ± SD	5.4 (1.0)	6.5 (1.3)	0.15
WAIS-R Digit Span backward, mean ± SD	4.5 (1.0)	5.2 (0.9)	0.15
Executive functioning
WFT, mean ± SD1
No. of good answers	42.7 (7.8)	48.2 (9.8)	0.29
No. of perseverative errors	0.28 (0.5)	0.47 (0.8)	0.58
Stroop Color-Word test, mean ± SD
Stroop 1 time (s)	43.9 (7.2)	39.2 (8.6)	0.41
Stroop 1 No. of errors	0.2 (0.4)	0.1 (0.3)	0.98
Stroop 2 time (s)	56.6 (8.3)	53.8 (6.9)	0.62
Stroop 2 No. of errors	0.3 (0.8)	0 (0.0)	0.21
Stroop 3 time (s)	88.3 (14.7)	76.6 (8.8)	0.22
Stroop 3 No. of errors	0.6 (1.5)	0.13 (0.3)	0.20
Stroop interference index	50.1 (7.8)	56.1 (5.5)	0.06
TMT, mean ± SD
Part A time (s)	30.3 (11.8)	22.1 (8.5)	0.08
Part A no. of errors	0.1 (0.2)	0.1 (0.2)	0.56
Part B time (s)	61.8 (29.2)	50.1 (17.4)	0.72
Part B no. of errors	0.1 (0.2)	0.2 (0.5)	0.41
WAIS-R Digit Symbol, mean ± SD2
Total score	59.7 (8.4)	71.0 (6.2)	0.06
No. of errors	0 (0.0)	0.1 (0.3)	0.63
Digit cancellation test, mean ± SD4
Total score	436.2 (88.1)	498.6 (82.9)	0.16
No. of good answers (%)	57.3 (29.5)	78.9 (20.9)	0.16
HADS, mean ± SD	13.1 (7.3)	4.8 (2.9)	< 0.001
Anxiety	7.5 (3.8)	3.7 (2.7)	0.002
Depression	6.1 (4.0)	0.9 (1.1)	< 0.001
SF-36
Physical functioning	72.9 ± 20.2	96.6 ± 3.4	< 0.001
Social functioning	52.0 ± 29.0	90.7 ± 9.8	< 0.001
Role physical problem	71.3 ± 37.4	2.9 ± 8.3	< 0.001
Role emotional problem	40.4 ± 46.1	2.0 ± 8.1	0.002
Bodily pain	35.3 ± 20.7	5.6 ± 12.6	< 0.001
General health perception	65.8 ± 18.8	82.0 ± 15.2	< 0.001
Mental health	63.6 ± 16.0	80.4 ± 10.9	0.001
Vitality	30.1 ± 18.3	72.9 ± 14.3	< 0.001

¹Missing in 2 CD patients;

²Missing 1 CD patient and 1 healthy control;

³Missing in 2 healthy controls;

⁴Missing in 5 patients and 3 healthy controls. To correct for multiple testing, the level of significance was set at P < 0.006 for the SF-36 score. MMSE: Mini Mental State Examination; WMS: Wechsler Memory Scale; WAIS-R: Wechsler Adult Intelligence Scale-Revised; WFT: Word Fluency Test; TMT: Trial Making test; HADS: Hospital Anxiety Depression Scale; CD: Crohn’s disease.

Table 5 Z-scores of the different domains of cognitive functioning

	CD patients (n = 20)	Controls (n = 17)	P value
Global cognitive functioning1, mean ± SD	28.9 (1.6)	29.7 (0.5)	0.870
Memory2, mean ± SD	1.1 (2.9)	1.3 (2.3)	0.007
Executive functioning3, mean ± SD	2.5 (7.7)	2.9 (4.2)	0.020

¹The global cognitive functioning domain includes the Minimal Mental State Examination;

²The memory domain includes the Wechsler Adult Intelligence Scale and the revised Wechsler Memory Scale;

³The executive functioning domain includes the Word Fluency Test, Stroop-Color-Word test and Trail Making Test. CD: Crohn’s disease.