Abstract Background Inflammatory bowel disease (IBD) is an condition that can influence neurocognitive function via the gutbrain axis. While research worldwide has linked disease activity to deficits data, from Middle Eastern populations remain sparse. Accordingly this study set out to explore the association, between cognitive impairment and inflammatory biomarkers in Saudi adults living with IBD. Methods A crosssectional snapshot was taken at IBD clinics in central Saudi Arabia. The study enrolled 74 patients diagnosed with Crohn’s disease 51, with colitis and a reference group of 40 subjects. Exclusion criteria included psychiatric or neurological disorders, language barriers, sleep disturbances, previous surgery, and use of steroids or other neuropsychologically active medications within 3 months before registration.Cognitive impairment was probed using the version of the Montreal Cognitive Assessment (MoCAArabic). Inflammatory burden was gauged through serum Creactive protein (CRP) levels and calprotectin (FC) concentrations. We examined the records, demographic profiles and treatment regimens of all participants. To compare groups we applied ANOVA or χ² tests; correlations were measured with Pearson’s r. Results Mean MoCA scores fell as disease activity climbed, dropping from 28.0 ± 1.8, in controls to 26.5 ± 2.2 in remission 25.2 ± 2.6 in mildmoderate disease and finally 24.0 ± 3.0 in cases (p 0.001). Among the IBD patients the average CRP was 14.2 ± 9.1 mg/L and fecal calprotectin 460 ± 320 μg/g—both values, than those observed in the control group (p 0.001). The cohort of individuals diagnosed with Crohn’s disease manifested Creactive protein concentrations (16.4 ± 8.9 mg/L) and fecal calprotectin levels (520 ± 340 μg/g) than the ulcerative colitis group (CRP 11.5 ± 6.2 mg/L; FC 390 ± 270 μg/g). Montreal Cognitive Assessment scores displayed a correlation, with both markers—CRP (r = –0.61 p 0.001) and FC (r = –0.65 p 0.001). Importantly these associations persisted after adjustment, for age educational attainment and disease duration. Conclusion In IBD patients the more inflammation flares up the cognitive performance wanes—a clear inverse link. Elevated CRP and fecal calprotectin emerge as harbingers of diminished MoCA scores reinforcing the notion that inflammation drives impairment. Thus weaving screening and a comprehensive psychological assessment, into the fabric of IBD care, across Saudi Arabia appears not merely advisable but essential. References: Zamani B, et al. Risk of Common Neurological Disorders in Adult Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. Aliment Pharmacol Ther. 2024;59(2):123–135. Zong X, et al. Inflammatory Bowel Disease and Risk of Neurodegenerative Disorders: A Meta-analysis of Cohort Studies. J Neurol Sci. 2024;455:120–129. Sârb AM, et al. Brain–Gut Interplay: Cognitive Performance and Biomarker Associations in Inflammatory Bowel Disease. J Clin Med. 2025;14(7):2293. Compare D, et al. Cognitive Impairment in Inflammatory Bowel Disease: Results from an ECCO Multicenter Cohort. J Crohns Colitis. 2025;19(Suppl 1):S215–S216. Conference abstractMo C, et al. Inflammatory Bowel Disease Accelerates Cognitive Decline in Patients with Dementia: A Nationwide Registry Study. Gut. 2025;74(5):812–820. Patel A, et al. Vascular Comorbidity and Cognitive Dysfunction in Inflammatory Bowel Disease: A Cross-sectional Study. Sci Rep. 2023;13:11542. Conflict of interest: Zacharakis, Georgios: Funded by Prince Sattam bin Abdulaziz University, Deanship of Scientific Research, College of Medicine, Research grant number: 2025/01/36462 Albadrani, Ahmed: This study was funded by Prince Sattam bin Abdulaziz University, Deanship of Scientific Research, College of Medicine, Kingdom of Saudi Arabia, research grant number 2025/01/36462 Al-Ghamdi, Sameer: No conflict of interest Alqahtani , Mohammed: This study was funded by Prince Sattam bin Abdulaziz University, Deanship of Scientific Research, College of Medicine, Kingdom of Saudi Arabia, research grant num5/01/36462. Alfateel, Noor: No conflict of interest Alhokel , Khalid: This study was funded by Prince Sattam bin Abdulaziz University, Deanship of Scientific Research, College of Medicine, Kingdom of Saudi Arabia, research grant number 2025/01/36462. Almalki, Daifallah: This study was funded by Prince Sattam bin Abdulaziz University, Deanship of Scientific Research, College of Medicine, Kingdom of Saudi Arabia, research grant number 2025/01/36462.
Zacharakis et al. (2026) studied this question.